- Northumberland NHS organisations and the County Council have put their Accountable Care Organisation plan on hold indefinitely.
- Through a System Transformation Board, they have been considering “potentially politically contentious” cuts across the Northumberland NHS and social care system, as well as how to implement Accountable Care financial and clinical models, without an Accountable Care Organisation or System to commission and provide them.
- The NHS organisations have paid an untold sum to Carnall Farrar consultancy company to advise on cuts, capacity and capability, and whether the 2018-19 operational plan is affordable, deliverable and committed to by the various organisations in the NHS and social care system.
In March, 999 Call for the NHS reported that Northumberland was rowing back from its plan to set up an Accountable Care Organisation – opting instead for other means of setting up an Accountable Care clinical model.
The System Transformation Board Update says that the Accountable Care Organisation development has been put on hold indefinitely
So Northumberland’s NHS organisations and the County Council now aim to implement the Accountable Care clinical strategy (developed over the past two years) “in the context of the existing commissioner-provider relationship”.
This clinical strategy focusses on out-of-hospital models of care – described elsewhere as “the redesigning of care around people at risk of becoming acutely unwell.”
The System Transformation Board is made up of the acute providers plus North East Ambulance Service, Northumberland County Council, the GP Federation and Northumberland Clinical Commissioning Group. Its remit is to collectively address issues of “local mechanisms of system leadership and the development of integrated care”.
(Integrated Care was formerly known as Accountable Care, until NHS England re-branded it in the Spring, to remove the pesky connotations of the USA’s Medicare/Medicaid system. This provides a limited range of state-funded healthcare insurance for people who can’t afford private health insurance.)
The Update to the Health and Wellbeing Board meeting says the key issue for the System Transformation Board is to:
“attempt to work together to achieve a financial system that has the capacity and capability to drive system change.”
What does that mean? At an informed guess, it means making cuts
Notorious Carnall Farrar consultancy company called in to “address the financial challenge”
The System Transformation Board Update says that Northumbria Healthcare Foundation Trust and Northumberland Clinical Commissioning Group have jointly commissioned the notorious management consultancy company, Carnall Farrar, to:
“support health and care leaders collectively to address the financial challenge faced by the Northumberland system and develop plans to drive transformation [and review] the affordability, deliverability and commitment to the 2018-19 operating plans, the capacity and capability for system delivery, and facilitate agreement for us as system leaders on a way forward.”
The need to pay a costly management consultancy company for advice on system integration seems a bit odd, given that “successful work over many years to integrate health and social care in one of the most rural counties in England” led to Northumbria Healthcare NHS Foundation Trust being chosen as one of only 9 sites in England to deliver an integrated Primary and Acute Care System (PACS) for the county.
“thanks to a long-standing and unique collaboration between Northumberland County Council and Northumbria Healthcare NHS Foundation Trust that…provides some of the best and most fully integrated care anywhere in the NHS, if not the world.”
Potentially politically controversial system-wide cuts
Perhaps Carnall Farrar has been employed because – according to the Northumbria hospitals trust 2016-17 AGM report – the System Transformation Board has been discussing options for “system wide efficiency opportunities” (ie cuts) that are “potentially controversial politically”.
It is always easier to impose politically controversial cuts if you can claim an independent management consultancy company told you to do it. Except Carnall Farrar is not independent.
Carnall Farrar – Hoovering up £ms of NHS money while telling NHS organisations to cut spending
Carnall Farrar is a revolving door business, whose partners used to work for NHS London before it was disbanded. (See December 2013 Times article: “NHS executives rehired as consultants after payoff”.) It also has strong connections with McKinsey – the American consultancy company that came up with the original £30bn NHS cuts plan in 2009, after the bankers’ crash bail-out swallowed £bns of our public money.
Carnall Farrar are making a killing going round the country charging a bomb to underfunded NHS organisations that NHS England and NHS Improvement have put into financial special measures, telling them to make the cuts in line with the quangos’ edicts.
Partner Ruth Carnall was chair of the Success Regime in NEW Devon.
She was also “Independent Chair” of the Programme Board of the Kent and Medway Sustainability and Transformation Plan, at the same time as Maidstone and Tunbridge Wells NHS Trust were paying Carnall Farrar £6,051,199 of NHS money for work on the Kent and Medway Sustainability & Transformation Plan.
Questions to Health and Wellbeing Board
The System Transformation Board Update raises many questions, which Northumberland campaigners are sending to the Health and Wellbeing Board meeting, as they’re unable to attend the meeting and ask them in person.
1) Carnall Farrar consultancy
a) How much is the 8 week Carnall Farrar consultancy costing?
b) What is their brief?
c) Was the consultancy advertised? If so, where? How was the decision made to employ Carnall Farrar?
d) Have Carnall Farrar reported on their review of ‘the affordability, deliverability and commitment to the 2018-19 operating plans’ yet?
e) If so, where is their report and what does it say?
f) If not, when will they report and will the report be publicly available?
g) Will the Carnall Farrar July report on Change Capability Assessment be publicly available?
h) Will the Carnall Farrar reports go to the Scrutiny Committee? Particularly given the potentially politically controversial nature of system wide efficiency savings under consideration by the System Transformation Board, according to the 2016-17 Northumbria Healthcare Foundation Trust AGM report.
2) System Transformation Board
a) When and where does the System Transformation Board meet?
b) Are the meetings in public?
c) Are the minutes public? If so, where are they accessible?
d) What are the broad principles of the system-wide clinical strategy discussed by the June System Transformation Board meeting?
e) What role does ‘demand management’ have in the clinical strategy – particularly in the elective care workstream?
3) Primary and Acute Care System Vanguard evaluation report
a) Where is the report? Is it publicly available?
b) What bearing do its findings have on the development of the system-wide clinical strategy?