Update – the VirginCare event about the Ealing Community Health Services contract has been rescheduled for Friday 17th August, https://www.eventbrite.co.uk/e/ealing-community-health-services-event-virgin-care-tickets-48731870336
Claiming to be “Organiser of Ealing Community Health Services”, VirginCare had scheduled an Ealing Community Health Services event on 31st July, 13:45 – 16:15 at Nelson Room, Ealing Town Hall:
“to engage with local community organisations to understand how services could be transformed”.
This is in advance of Ealing Clinical Commissioning Group’s recommissioning of Ealing’s various community health and social care services in a single Out of Hospital Services contract.
Jumping the gun
The contract was still open on 17 July when VirginCare posted the event brite invitation to their event. The deadline for bids was 19 July. This makes their claim to be organiser of Ealing Community Health Services look like jumping the gun.
If anyone would like to ask them about this, their email address is email@example.com
Also on 17th July, Ealing Community and Voluntary Services emailed the invitation to local organisations on behalf of VirginCare, saying
“This will be an informal event and will give you the opportunity to have your say and to discuss how a community health services provider could work in collaboration with local community organisations to better meet the health needs of Ealing residents.”
The business case for this contract has been drawn up in secrecy
Ealing Clinical Commissioning Group has justified this on the grounds that the info in it is commercially confidential. It has been mentioned in Ealing Clinical Commissioning Group Governing Body minutes, but never presented publicly.
The contract is large – 10 years, £450m, to transform all Ealing community health and social services – both NHS and Council. The contract notice says that in addition to the £450m which bidders compete for, there are two other financial elements:
“Access to potential transformation funding of £47,405,694 over the maximum10 year contract term. This value will not form part of the award criteria and cannot be relied on as a funding source for bidders
Scope of potential additional services over the term of the contract, which has an annual equating to approximately £79,926,000.This value will not form part of the award criteria and inclusion will be subject to a due diligence process during the contract term-therefore Inclusion of these services should not be relied upon by bidders. Where services are included into the scope a reasonable view of growth in funding may need to be applied”
Apparently there are 22 of these additional services that could come into the contract when their existing contracts expire. They include GP out of hours services, primary care out of hospital services, health visiting and school nursing.
Update 18 Jan 2019 – Ealing Clinical Commissioning Group has awarded the contract to “a new partnership of local providers, led by West London NHS Trust.” The “partnership” consists of
- West London NHS Trust (lead provider)
- Central & North West London NHS Foundation Trust
- The Hillingdon Hospitals NHS Foundation Trust
- Ealing CCG
- Ealing Council
- Ealing GP Federatio
- And :
NHS Improvement and NHS England will seek assurances from Ealing Clinical Commissioning Group and West London NHS Trust that:
the services can be delivered safely and effectively, without undue financial risks.
Ealing Clinical Commissioning Group and Ealing Council are both underfunded and short of money, so this contract will aim to cut costs
This doesn’t seem to be mentioned publicly anywhere, although the Prospectus points out rather ominously that,
“Importantly organisations across NW London are working towards delivering a financial sector control total and the provider would be expected to play its part in meeting these requirements.”
The new contract aims to transform all Ealing’s NHS and social care services
Although acute (hospital) and primary care services are out of scope of the contract, they too will be transformed by it.
The Contract Prospectus says that community health professionals will be
“delivering at the top end of their licence, enabling primary care to focus on population health management and acute teams to focus on people requiring specialist provision.”
The relationship between clinician and patient will be radically changed by this new contract and related changes in primary and acute care – and not for the better.
Population health management – the business of Accountable Care Organisations
Population health management completely changes the relationship between clinician and patient: it is about risk stratification of patients and then getting patients in whatever risk group they are allotted to, to adopt prescribed healthy behaviours.
This ignores the fact that ill health is disproportionately associated with poverty and deprivation. It would be better for the government to tackle poverty and deprivation than pressurise people on low incomes in unhealthy neighbourhoods to adopt so-called healthy behaviours, which demand resources they don’t possess. It ignores the economic, environmental and social determinants of ill health – letting the government off the hook of regulation and legislation that would improve public health.
This is an essentially neocon version of healthcare. This is why 999 Call for the NHS is calling for #Justice4NHS in our application to appeal the ruling against our judicial review of the Accountable Care Models contract payment mechanism.
Population health management requires an “Accountable Care” approach to how commissioners pay for health services
Instead of being paid for treatment they actually give patients, providers are paid a fixed sum per head for population health management, with a risk/gain share agreement.
Providers are required to hit targets for various outcomes at the level of population health. eg reduced unplanned hospital admissions, better control of diabetes, etc. If they spend less than the fixed amount for their population, they keep some of the unspent money. If they spend more, they have to deal with the consequences.
Where this has been practiced in other countries, it has led to cherry picking patients who are cheaper to treat and offer a better “return on investment.”
One of the risk categories in population health management includes the most expensive patients – those who are at high risk of unplanned hospital admissions because of chronic and deteriorating illnesses or frailty.
For these patients, “virtual wards” are created that share patients’ data including remote monitoring by telehealth and telecare digital gadget. The aim is provide care to patients when they show symptoms that could lead to illness requiring hospital admissions, with a view to preventing such admissions.
There is little evidence population health management works – either in the USA, where it hails from – or here . A fairly recent study of the effects of extra GP funding for an “enhanced service specification” to reduce unplanned hospital admissions found that it resulted in more unplanned hospital admissions. I can’t at the moment put my hands on the reference/link for this study, sorry.
Update 14 September 2018 – 2 NHS Trusts withdraw from bidding as the contract is too cheap to provide safe services
The cost pressures in this type of contract are obvious from the fact that TWO local NHS trusts have now withdrawn from bidding for the Out of Hospital Services contract, because there’s not enough money in the contract to provide safe, effective, high quality services. Both Central London Community Healthcare Trust and London North West University Healthcare Trust have said they are not going to put in a bid, for that reason.
Both NHS Trusts provide several community services in Ealing, and will lose many of them when the commissioner awards the contract. This will not help the Trusts’ finances, or their staffing, as they will lose income and staff.
Ealing Integrated Care System – IT and digital innovation are paramount
The single contract for Out of Hospital Services is a key element of the creation of an Ealing Integrated Care System – part of the wider NW London STP.
The Ealing Integrated Care System is to be based on “new care models” that were specified NHS England’s 5 Year Forward View and have been piloted in around 50 Vanguard schemes over the last few years – with mixed results.
The final Prospectus for the single contract for Out of Hospital Services refers to the Multispecialty Community Providers model and related new commissioning models used by Greater Manchester and Dudley. It also mentions that IT and digital innovation will be paramount, and that there will be a digital provider that the main provider will have to work with.
However GP Margaret McCartney has criticised the
“misty belief that more technology and innovation will save General Practice”
She has also pulled to pieces a costly, flawed PriceWaterhouseCooper report for the Department of Health that made un-evidenced claims for benefits of IT for the NHS.
Current Ealing community health services providers
The list shows how, if the contract were to go to VirginCare, this could seriously damage London North West Healthcare Trust, and lead to its community services staff being transferred to Virgin.
Innovative legal ruling recognised that the NHS stands or falls on the basis of providing the whole range of healthcare
The two NHS Foundation Trusts in Lancashire that held the children’s services contract made a successful legal challenge when Lancashire County Council awarded a new £100m children’s service contract to Virgin Care.
An innovative interim ruling against Lancashire County Council recognised that the NHS stands or falls on the basis of providing the whole range of healthcare. The ruling also pointed out that this disruption and damage was not adequately factored in by the council in deciding to award the contract to Virgin Care.
But unlike the Lancashire County Council contract, the Ealing single contract for Out of Hospital Services is a lead provider contract. This means that the organisation that is awarded the contract will subcontract out bits of it to other providers. Probably including a quite a lot to voluntary and community organisations.
Community NHS and social care services in the single contract for out of hospital care
The Primary Care Home is 7 large scale GP practices. This is a radical departure from traditional GP practices, as already outlined above in the Population health Management section.
There are plans for 3 Primary Care Hubs, where patients will have to come to access some services that are not provided in individual GP practices – particularly many services that were previously provided in hospital.