Privatised diabetic retinopathy screening – far more than meets the eye

Alerted by an appointment letter to a Huddersfield patient, directing them to a Diabetic Eye Screening appointment at Specsaver, I looked on the Greater Huddersfield Clinical Commissioning Group website for information about privatisation of the Diabetic Eye Screening service.

I found this:

“Q:Who is the current contracted provider of the Diabetic Eye Screening Programme  in the CCG area?
A: Greater Huddersfield CCG does not commission Diabetic Eye Screening.”

So Greater Huddersfield Clinical Commissioning Group didn’t answer the question. As usual.

Privatised Diabetic Eye Screening Service for West Yorkshire and Craven 

Why didn’t they just say that Emis Care is the current contracted provider of the West Riding and Craven Diabetic Eye Screening Programme – which includes the Greater Huddersfield Clinical Commissioning Group area? And that NHS England commissioned the Diabetic Eye Screening Programme?

A company registered in Leeds, Emis Care claim to be:

“the UK’s leading independent company in providing diabetic eye screening services to the NHS. With over 30 years’ experience, we provide seven large-scale screening services across the UK and Republic of Ireland to over 500,000 patients…”

Emis Care has jumped on NHS England’s patient self-care/behaviour change bandwagon, by publishing feet information “prescriptions” for people with diabetes.

However, as ck999 pointed out last year in our review of the new NHS England Diabetes Pathway,

“The pathway’s focus on individual behaviour change ignores the link between poverty/deprivation and diabetes.

In the light of evidence that diabetes is higher among people on low incomes and experiencing deprivation, we have to question the diabetes pathway’s focus on individual behaviour change as the key means of preventing diabetes and improving the health of people with diabetes.

A 2016 Study of social inequalities in relation to diabetes and impaired glucose regulation found that social inequalities in hyperglycaemia (high blood sugar) exist. Age standardised prevalence of diagnosed and undiagnosed diabetes and impaired glucose regulation was highest among Asian and black participants. They were also higher among people with lower income, less education, lower occupational class and greater deprivation. Lower or no educational qualifications and low income are significantly associated with impaired glucose regulation or undiagnosed diabetes. (Moody A, et al. BMJ Open 2016;6:e010155. doi:10.1136/bmjopen-2015-010155)”

Health software company riding on Sustainability and Transformation Plan digitech wave

Emis Care is part of Emis Health, also registered in Leeds –  a health software company which claims to be

“the leader in connected healthcare software and services. We provide every health sector with innovative technologies, from market-leading clinical management systems to health analytics tools…”

Emis Health also claims that

“You’ll find EMIS Health systems across every major UK healthcare setting.

Our technology is the number 1 or number 2 choice in primary and community care, high street pharmacies, secondary care and specialist services.”

The Emis Care Diabetic eye screening programme dovetails with Emis Health IT systems:

“We provide IT systems for image management and storage for clinical ophthalmology. Our software for managing diabetic eye screening is used by the majority of programmes in England and has helped assess over 11 million patients since 2005.”

Sustainability and Transformation Plans and Accountable Care Systems are key to Emis’ profitability

Both Emis Care and Emis Health are part of Emis Group

“a major provider of healthcare software, information technology and related services in the UK.”

The Chief Executive’s Overview of the 2017 Half Year financial results explains that  Sustainability and Transformation Plans and Accountable Care Systems are key to Emis Group’s future profitability:

“While funding challenges and political events have delayed IT investment by STPs, EMIS Group continues to work with key STPs and remains confident that its integrated healthcare technology will be an attractive proposition in this emerging market.

“In June 2017, Simon Stevens (Chief Executive of NHS England) announced funding of up to GBP450m over four years to support, initially, eight localities (STPs or parts of STPs) to create Accountable Care Systems. These will provide joined-up and better coordinated care, breaking down the barriers between GPs and hospitals, between physical and mental healthcare, and between social care and the NHS, controlled through a unitary budget. In anticipation of this, EMIS Group has been investing in its integrated and interoperable EMIS Web platform to underpin these new models of care. EMIS Health is already embedded in many of these localities as the provider of primary care, community, acute and community pharmacy solutions.”

Emis Group must reckon it has hit the jackpot.

Emis Health has a massive range of IT products that it has “partnered” with NHS England to push as key to the digitech-driven “new care models” being imposed via Accountable Care Systems (now variously rebranded as Integrated Care Systems, Integrated Care Organisations, Primary Care Homes and a farrago of other names) across our NHS.

Private provider of patient self-care info

The patient self-care mantra – pushed by Sustainability and Transformation Plans/Accountable Care Systems under whatever name – is a way of simultaneously cutting costs and sidestepping the failure to come up with a decent workforce strategy that provides adequate numbers of NHS clinicians. This must also be music to Emis Group’s ears.

As well as Ennis Care’s feet information “prescriptions” for people with diabetes, the Emis Group includes the Patient “brand”.

The financial market website ADVFN  describes Patient as:

 “the UK’s leading independent provider of patient-centric medical and wellbeing information and related transactional services.”

Adding:

“With increasing pressure on NHS resources, Jeremy Hunt, Secretary of State for Health, has been at the forefront of exploring and promoting self-care models underpinned by digital technology.”

In mid 2017, Patient revenue was up 42%, with an adjusted operating loss of GBP0.3m. This was due to the costs of its expansion.

The Patient website is

“Designed to help patients play a key role in their own care, it provides access to over 4,000 clinically authored health information leaflets, videos, health check and assessment tools and patient forums.

Patient Access allows patients to book GP appointments, order medication and view their own medical record.”

Unsurprisingly, Optum – part of United Health, the huge American health insurance company that was the former employer of NHS England’s boss – is cosying up to Emis.  

Optum is sponsoring the Emis National User Group Sept 2018 conference in Birmingham

In the UK,   Optum sells the NHS what it needs to morph into a version of United Health:

Optum and Emis Group appear to be carving up the Accountable Care digital technology “market” between them.

UnitedHealth, through its minion Simon Stevens at the helm of NHS England, is out to control, sideline and override NHS doctors’ treatment decisions, with the aim of “managing demand” and cutting costs.

This amounts to de facto privatisation, as it drives patients who can afford it to pay for private health care.

Key to this is NHS England’s current consultation on stopping funding numerous elective care treatments.

So is NHS England’s  mandatory Integrated Urgent Care Service, being rolled out across England by April 2019.  This removes patients’ direct access to clinicians in a whole range of services and redirects them through NHS 111 to a clinical advisory service that works off the algorithms of a digital  clinical decision support tool.

Update 5 August 2018

Emis Care is not the only private company commissioned to provide the NHS Diabetic Eye Screening Programme.  InHealth – which we have already blogged about in relation to the privatised pain management service in Greater Huddersfield – delivers the NHS Diabetic eye screening service across Berkshire, Dorset, East Anglia, Essex, North West London & Portsmouth, covering 28 CCGs and nearly half a million patients.

 

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7 comments

  1. Why would Greater Huddersfield Clinical Commissioning Group avoid answering the question of who they commission to provide a diabetic eye screening service? Everywhere we are now getting told we are being consulted and the processes involved in running our local NHS are clear and open. Yet wherever we ask a question in CCG committee or make an enquiry on-line the answer is not forthcoming. What have the authorities got to hide?

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    • CCGs have never commissioned diabetic eye screening. This is a national service commissioned by NHSE. The CCGs response is correct as they can’t provide information on a service they are not involved with. Not everything is a conspiracy.

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  2. According to the EMIS care website.
    “The Lancashire Diabetic Eye Screening Program is provided by EMIS Care. NHS England has appointed EMIS Care to deliver the service on their behalf. This means your diabetic eye screening programme is still an NHS screening service but will be delivered by EMIS Care in partnership with the NHS”.

    the private providers EMIS are thus delivering the service on behalf of the NHS.
    It was previously provided by The NHS in Lancashire (East Lancashire and Preston, Chorley and South Ribble) but these were stripped of the service in October 2016 and handed to EMIS Ltd.
    So it appears the merger enabled NHS England to do the commissioning instead of each individual CCG.

    that’s what could happen in future with services commissioned by commissioning support units (CSUs) with CCGs being micro-health insurers under accountable care organisations. After all Prior to 1 April 2013, NHS England was known as the NHS Commissioning Board….

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  3. I do think that everyone is missing the point here. The implication is clearly that diabetic retinopathy screening used to be provided by the mainstream NHS and that it has somehow been privatised recently and by some dastardly and underhand process of NHS England. This is simply untrue. Historically, where diabetic retinopathy screening was commissioned within the NHS at all, it was commissioned piecemeal by the former Primary Care Trusts from individual high street opticians’ practices, who are of course private contractors to the NHS.

    The West Riding and Craven Diabetic Eye Screening Programme is simply an attempt by the North Regional Office of NHS England (it’s not a nationally commissioned service as suggested by a previous poster) to organise and standardise what had sometimes been a rather scrappy service within Yorkshire.

    EMIS, incidentally, stands for Egton Medical Information Systems. EMIS are an offshoot from a general practice database company originally developed in his spare time by a country GP from Egton near Whitby in North Yorkshire. None of what has happened is as Machiavellian as some people seem to want to make it sound. Sorry if that’s not what you wanted to hear.

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