Scrap Accountable Care and update the NHS Reinstatement Bill

The whole notion of Integrated Care Providers  – formerly called Accountable Care Organisations – should be scrapped.

The privatisation aspect of Integrated Care Providers is not their sole problem.

We oppose them because of their explicit ‘demand management’ rationale and the fact that they would cement the import into the NHS of the USA’s Medicare/Medicaid care models and workforce practices.

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These new care models are the result of successive governments’ policies and programmes – starting under the New Labour government and culminating in the 5 Year Forward View that Simon Stevens introduced in 2014.

The new care models are based on cutting and centralising acute and emergency hospitals, turning District General Hospitals into planned care clinics or satellite urgent care hospitals where patients can be stabilised before being sent on to major trauma/Emergency Department hospitals, and setting up out-of-hospital services in large scale primary care practices based on GP lists of 30-70K patients.

All these structural changes are underpinned by the introduction of tightly controlled criteria for patients’ access to NHS treatments. Criteria that are based on financial considerations, not patients’ clinical need.

The result is to restrict patients’ access to NHS treatments and to undermine doctors’ professional competences and the doctor-patient relationship.

This is because the plan is for GPs to be largely replaced by lower-skilled grades of associate staff who will make diagnoses and treatment decisions largely on the basis of computer clinical decision models. This fundamentally undermines the core NHS principle that it is a comprehensive service where all patients can access treatment on the basis of clinical need.

Integrated Care Providers are not just about traditional NHS cuts, closures and privatisation – their introduction is about the stealth transformation of the NHS into the Medicare sector of the larger UK “health economy”, with the NHS as a provider of last resort for people who are too poor or ill to get private health insurance cover.

The rollout of new Accountable Care models would be damaging EVEN IF they were delivered by statutory NHS organisations.

This is why we can see no point in legislating for Integrated Care Providers. Turning them into statutory bodies would not solve the problems they would create.

New 10 year plan for the NHS

Simon Stevens reportedly wants “pragmatic” legislation to cement his intended transformation of the NHS into a version of the USA’s Medicare/ Medicaid system – by way of the new 10 year plan for the NHS. We cannot support this.

The Health Service Journal reports him as saying statutory changes should include

  • Supporting “the ability for local NHS organisations to function in a way that is more consistent with the move towards systems working [and population health]” – this is about Sustainability and Transformation Plans/Partnerships and the Integrated Care Systems they are morphing into, and no doubt also the Integrated Care Providers they would commission.
  • Removing “impediments [to local organisations working as systems] which exist [in] procurement and competition legislation”; – this sounds like repealing s 75 of the 2012 Health and Social Care Act

NHS England is going to have an “engagement process across the NHS about the 10 year plan between December and Easter” in order to build consensus around the “appropriate legislative changes”.

We should start shouting for this to be a public consultation – not an NHS engagement process.

And we should start shouting our opposition to legislation to cement the transformation of the NHS into a version of the USA’s Medicare/Medicaid system by way of Sustainability and Transformation Partnerships, Integrated Care Systems and Integrated Care Programmes and Providers – or by any other route.

Whether or not this transformation is carried out by statutory NHS organisations, it would still be a disaster for the NHS as a comprehensive universal service. As we keep saying.

We need an updated NHS Bill  – to prevent the hijack of the NHS by life sciences, big pharma and digital technology companies

In the face of these developments, we need to be loudly advocating for an updated NHS Reinstatement Bill that restores not only the core NHS principles, but extends them to social care.

An NHS Bill that reinforces the principle of universal access to comprehensive services based on decisions made together by patients and doctors on the basis of clinical need and patients’ values – not on financial considerations.

An NHS Bill that puts medical innovation into public hands – in order to protect the NHS from the real agenda of Accountable Care: what Ernst and Young calls capturing value from the human body as data platform.

This is the facebook model of healthcare, where an apparently free service is monetised by capturing users’ data.

In pursuit of this goal, the NHS is being being redisorganised into a testbed for life sciences and digital technology corporations’ “disruptive innovations”.

Post-Brexit, the government’s aim is to export these disruptive innovations to China, India, Saudi Arabia, Africa…, leaving NHS patients stranded high and dry with a rump service, while the huge wealth of 70 years of millions of patients’ confidential medical data is mined for the profit of life sciences and digitech companies.

You just have to watch NHS England’s Director of Transforming Health Systems Michael Macdonnell jump ship to join Google’s Deep Mind Health.

His job will be to strengthen DeepMind’s partnerships in the NHS and overseas with the aim of applying AI to clinical practice.

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Accountable/Integrated Care business and clinical models – whatever rebranded names they may go by – serve the interests of life sciences and digital technology companies, not of NHS frontline staff, patients and public.

The recent Darzi/Institute for Public Policy Research report makes this clear.

And so does May’s speech about the promised £20bn extra NHS funding by 2023.

To prevent the hijack of the NHS by life sciences, big pharma and digital technology companies, we suggest that an updated NHS Reinstatement Bill must bring the development of drugs and life science/medical technologies into public ownership through the establishment of a National Health Innovation Authority, and at a regional level, should replace Academic Health Science Networks with regional Health Innovation Boards.

This would restore evidence-based, clinically effective practices and cut costs by ending profiteering. It would redesign medical innovation as “Health Innovation as a public good”, driven by public health needs and social justice. This must be transparent and accountable to the public; deliver products and interventions that improve health outcomes, and that are accessible and affordable to all; and it must contribute to the progressive realization of the right to health.

There should be clear guarantees about data protection for patients’ confidential medical data and a refusal to put this on the market for purchase by private companies. This huge unparalleled source of health data must remain in public ownership for the public benefit.

There are other key updates we would like to see in the next version of the NHS Reinstatement Bill.

It should declare the principle of a “health in all policies” approach to public health – requiring environmental, social and economic legislation to be health promoting and to effectively tackle the environmental, social and environmental determinants of poor health.

It should make a clear statement that ill health is strongly associated with poverty and deprivation, and should make it clear that nudge and behaviour change schemes are not appropriate or effective means of improving public health.

It should restore the principle and practice of the central importance of the personal doctor-patient relationship as the key means of deciding on patients’ access to approved treatments that are appropriate to their circumstances and values.

It should abolish current measures to restrict this through population health management that is based on a business model where financial considerations override patients’ and doctors’ decisions about the best treatment to be undertaken. And that replace doctors’ referral decisions with computerised clinical decision models and/or referral management companies.

We have everything to fight for. So let’s keep at it.

2 Cheers for the 2018 NHS Bill

999 Call for the NHS have strongly supported the NHS Reinstatement Bill for 4 years now.

We 100% support the renationalisation of the NHS – and bringing adults’ and children’s social care onto the same footing as the NHS:  publicly funded, managed and provided, and free at the point of need.

But we are worried about the new NHS Bill’s proposals for the ‘integration’ of NHS and social care. (‘Integration’ being a weasel word for ‘market-focussed imports from the USA’- as pointed out 21 years ago by Chris Ham of the Kings Fund, when the plan was first being hatched.)

Specifically, we are worried about the Bill’s clauses on:

  • new legislation about the integration of NHS and social care,
  • the functions and membership of the Strategic and Local Integrated Health Boards,
  • the sequence of events for integrating Health and Social Care, and
  • whether the integrated NHS and social care services would be provided along the same Accountable Care lines as currently proposed by NHS England

Questions about the NHS Bill’s clauses on the integration of NHS and social care

The 2018 version of the NHS Bill says that the Sec of State has to review the provision of  social care services in England, including:

  • the basis for funding them,
  • whether Integrated Health Boards should be responsible for providing social care services, and what legislation is needed to enable the integration of health services with social care services

Key issues for us are : Would this legislation specify that social care would be publicly funded and publicly provided? And would people access it free at the point of need, like NHS services?

Or would social care services when integrated with the NHS, still be means-tested and provided by private companies and third sector organisations?

Would the proposed new ‘integration’ legislation look for a different model of NHS and social care integration than that proposed by NHS England and currently being set up by Sustainability and Transformation Partnerships and Integrated Care Systems?

Or would it serve to cement this Medicare/Medicaid import into the NHS?

Here’s more info (pdf) about our questions about the October 26 2018 NHS Bill.

 

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