Kirklees’ out-of-hospital integrated care system aims to change the relationship between patients and NHS

  • Kirklees is now well on the way to setting up a cost-cutting integrated out of hospital care system.
  • It is vital that Calderdale and Kirklees Joint Health Scrutiny Committee scrutinise this, as part of the review and reworking of the hospital cuts and care closer to home plan ordered by the Secretary of State.
  • The Yorkshire and Humber Academic Sciences Health Network – a limited company licensed by NHS England to promote Life Sciences and Healthcare as important sectors to generate new economic growth – is involved in setting up the out of hospital integrated care system

Kirklees and Greater Huddersfield Clinical Commissioning Groups and Kirklees Council have taken a big step towards setting up a cost-cutting place based Accountable Care System – rebranded as Integrated Care – to provide out of hospital care.

Kirklees NHS and social care services face a shortfall of over £200m in 2020/21, if current ways of providing services don’t change.

To bring about these changes, the Clinical Commissioning Groups’ Governing Bodies and Kirklees Health and Wellbeing Board (chaired by the Council Leader) have all approved Terms of Reference for an Integrated Commissioning Board, which started work in April as a Joint Committee of all three organisations.

It intends to commission:

“an integrated model of health and social care outside hospital [that] must have modern primary care at the centre.” (Kirklees Integrating Health and Social Care – Case for Change)

Shifting healthcare spending away from acute hospital care towards community and primary care services is a strategic objective of the Clinical Commissioning Groups. To this end, the Kirklees Integrated Commissioning Board is to develop:

“new models for integrated commissioning and delivery of services…[to] …ensure that the local commissioning of health, social care and public health is…in line with national policy… and supports the development of the West Yorkshire and Harrogate Health and Care Partnership” [ie West Yorkshire and Harrogate Sustainability and Transformation Partnership – itself now an Integrated Care System.]

National policy for integrated NHS, public health and social care commissioning revolves around contentious plans for Accountable Care Organisations and Systems – which NHS England recently rebranded as Integrated Care.

In written and oral deputation statements to the 22 Feb 2016 Joint Health Scrutiny Meeting, Save the NHS campaigners showed that integration of health and social care threatens the survival of the NHS, by merging it with cash-strapped, means tested, largely privatised council social care and leisure services and a wide range of other local authority and central government public services.

Calderdale and Kirklees Joint Health Scrutiny Committee must scrutinise these proposals

The plan to commission and deliver a new integrated model of out of hospital services, with “modern primary care at its centre”, is tightly tied up with the contentious hospital cuts plan.

11 months ago, Calderdale and Kirklees Joint Health Scrutiny Committee referred these plans to the Secretary of State’s Independent Reconfiguration Panel, as not in the best interests of the public.

The Sec of State and his Independent Reconfiguration Panel have given local NHS organisations until mid August to make the hospital cuts and community health services plans fit for purpose, before the Secretary of State makes a final decision about the future arrangements for hospital and community health services in Calderdale and Greater Huddersfield.

Failings identified by the Independent Reconfiguration Panel include plans for the delivery of out of hospital care. They told the local NHS organisations and Calderdale and Kirklees Joint Health Scrutiny Committee that this is one of the things they should focus on.

The Independent Reconfiguration Panel has also told them to examine the likelihood that the Care Closer to Home plans can achieve the targeted reduction in demand for hospital care, and also make sure that over the whole period of implementation, out of hospital care services are in place before hospital bed numbers are cut.

Calderdale and Kirklees Joint Health Scrutiny Committee must examine both the Kirklees Integrated out of hospital care system and its counterpart in Calderdale – Calderdale Care.

Russian doll-type nested accountable/integrated care systems will transform GP practices

Kirklees Integrating Health and Social Care Case for Change says that future delivery of health and social care in Kirklees will be through “one place based out-of-hospital care delivery system”, commissioned by the Integrated Care Board.

Primary care in Huddersfield and North Kirklees will operate on smaller footprints, says the Case for Change. Groups of GP practices will form “locality” accountable/integrated care systems each serving a population of at least 30k-50k people.

This involves redesigning GP services – a significant service change.

Where has this been consulted on? It hasn’t.

Greater Huddersfield CCG is working on this redesign with individual GP practices reps and the My Health Huddersfield GP Federation. They are

“promoting patient involvement and ownership of their own health and wellbeing.”

New GP commissioning and governance methods

This “redesign” of GP services involves a big change to the methods of commissioning them. The Clinical Commissioning Groups are developing a “lead provider” governance structure. This is being “supported” by the Yorks and Humber Academic Health Science Network – a limited company licensed by NHS England  to promote the government’s agenda of:

“Life Sciences and Healthcare as important sectors to generate new economic growth as well as increasing the quality of care for patients within the NHS.”

NHS England’s website says:

“AHSNs have been established to deliver a step-change in the way the NHS identifies, develops and adopts new technologies and are predicated on partnership working and collaboration between the NHS, academia, the private sector and other external partners within a single AHSN context and across AHSNs.”

It refers to Academic Health Science Networks as “system integrators” whose job is:

“to lead large scale, sustainable transformational change across traditional boundaries…each AHSN also has the remit to bring together the resources and assets in their geography to create a synergy between researchers in universities, industry and entrepreneurs, and the local NHS to identify, exploit and commercialise innovations that will have national and international significance.”

Companies House shows that three of the four Yorkshire and Humber AHSN directors mix public sector and corporate interests:

  • Andrew Cash is also the South Yorkshire and Bassetlaw Integrated Care System lead, Chief Executive of Sheffield Teaching Hospitals NHS, Director of NHS Confederation and Director of management consultancy company Unique Health Solutions Ltd
  • Christine Audrey Outram is also Director of Foundation Trust Network , Manchester Academic Health Science Centre , Holgateside ConsultingSt Annes Community Services Leeds, which rents and operates Housing Association real estate, provides Residential nursing care facilities, Residential care activities for learning difficulties, mental health and substance abuse and Other non-residential social work activities
  • Professor William Pope is also Director of University of Suffolk Ltd; Connected Together CIC , which carries out Market research and public opinion polling and was previously named HEALTHWATCH NORTHAMPTONSHIRE CIC; and Unity Leisure Ltd , which operates sports facilities.
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