A father writes:
“I spent this morning in my son’s Type 1 diabetic clinic (after 35 years of my own experience of Type 1 diabetic treatment) learning that the NHS is now just a ‘conduit’ for private sector ‘providers’.
“Treatment of T1 diabetes is currently undergoing a technological revolution, at least for some. It’s important to note the longstanding and increasing geographic and social inequalities in access to care for T1 diabetes, and also the worrying data on outcomes at a time when things should be getting a lot better.
“The new technologies include insulin pumps, continuous monitoring systems, and soon hybrid loop pump systems (and on the horizon ‘intelligent’ insulin). They all improve blood glucose control, allow for greater freedom and flexibility of management, result in improved health outcomes, reduce complications, improve quality of life, and lead to medium and long-term savings for the NHS (preventing expensive complications etc) in addition to the wider benefits to individuals, families, communities and society (+ a nod to the current short-term, false economies of denying access based on postcode and the inverse care law).
“What I’ve been observing is the creeping privatisation of T1 diabetic care through the control and provision of technology. In the past, new devices like insulin pens and finger prick monitoring systems were delivered by the NHS with little or no patient contact between pharmaceutical companies and the patient.
“Private companies’ new and poorly trained staff treat the delivery of a life giving device the same as when private companies deliver a TV or a toaster”
“Today private companies are increasingly delivering the technology directly (literally, as you order supplies on the phone and they are sent to patients in the post – via typically new and poorly trained staff that treat the delivery of a life giving device the same as when private companies deliver a TV or a toaster. In my experience for example they’ve failed to pass essential information between companies, failed to deliver life essential supplies, sent kit to the wrong address, provided ‘corporate BS’ as excuses).
“They are increasingly providing training for the devices directly, and are now even providing some (poor) online training that is required before you can get access to devices such as the Freestyle Libre. They are also forcing us to hand information to private companies to gain access to monitoring software – and we have no idea what they might do with this information in the future. [ck999: An article on the Digital Health London website gives a pretty good idea of what they’re doing with patients’ data – more info below.]
“So, it isn’t a straightforward ‘I’m now attending a private clinic’, but they have crept into the provision of care. It is, as the technological revolution develops, increasingly the most important element of our care. This is particularly so for children as they are usually the first to be given access to new technology as they have the most to gain.
I see no reason why the NHS can’t deliver these devices and services (equitably and supported by the NHS ethos, not one of people that sell toasters!), apart from the short-sighted economics.”
NHS England – not just buying digital technology, but handing over patient support and education to digitech companies
NHS England’s Diabetes Prevention Programme – digital stream has been running a pilot scheme in eight Sustainability and Transformation Partnership areas to test the effectiveness of digital kit in supporting behaviour change schemes aimed at preventing people clinically at risk of developing type 2 diabetes, from doing so.
It seems that this involved an evaluation – carried out by global accountancy company RSM – of the digitech companies’ level of operational support for implementation and ongoing support for referrals.
This bears out the experience related above, that NHS England is not just buying wearable digital technology for patients’ use, but is handing over patient support and education to the digital providers too.
Digitech companies are data mining patients’ data to provide the basis for insurers’ payments to healthcare providers
Clinical outcomes – rather than the health service provided – are increasingly the basis for insurance companies’ payment to healthcare providers. This is because with the growing numbers of people with chronic illnesses, insurers are looking for ways to pass the risks onto health care providers.
The article – reblogged from digital health consultancy company DigitalSalutem – cites the USA’s Medicare scheme as the most advanced in terms of paying healthcare providers on the basis of outcomes: 50% of its payments to healthcare providers are now based on outcomes.
Aligning the NHS with the USA’s Medicare insurance scheme
This of course is the method that NHS England aims to introduce with its proposed Integrated Care Provider contract (which 999 Call for the NHS is challenging in the Court of Appeal later this autumn) and other forms of contracts, such as aligned incentives contracts, that Clinical Commissioning Groups are increasingly entering with hospitals Trusts. This basically replicates the Medicare insurance model by using outcomes as a basis for payment as a way of passing financial risks to providers, in order to “incentivise” them to “manage demand” for patient care and so cut costs.
NHS Detectives Think Paddling Pool reported last year on a new diabetes pathway GPs are to follow when treating patients with diabetes.
The Diabetes Transformation Fund, initially started as part of NHS England’s 5 Year Forward View was later incorporated into Sustainability and Transformation Plans/Partnerships.
The aim is to promote the following outcomes in the treatment and care of people with diabetes:
- increasing uptake of structured education
- improving achievement of the NICE recommended treatment targets (HbA1c, blood pressure and cholesterol for adults, HbA1c only for children)
- reducing the number of amputations by improving access to multi-disciplinary foot care teams
- reducing lengths of hospital stays by improving access to specialist inpatient support.