Self congratulatory laughter united House of Commons Health & Social Care Committee MPs, Health Secretary Matt Hancock MP and NHS England boss Simon Stevens at the 28.1.19 meeting on the NHS Long Term Plan.
There were mutual congratulations that the NHS Long Term Plan follows the Health and Social Care Committee’s recommendations for turning the NHS into a set of local Accountable/Integrated Care Systems.
These recommendations were made in the Committee’s report last summer.
The report accused NHS campaigners of producing “inaccurate, misleading” messages that “play on the public’s genuine concerns” and of “projected fears” which “are making the challenge of integrating care more difficult.”
In the 28.1.19 meeting this theme continued, with Simon Stevens contemptuously dismissing public worries about increased NHS privatisation under Integrated Care Systems as a belief that’s
“not shakeable by any empirical evidence.”
On the contrary. There’s plenty of empirical evidence that the imposition of Accountable/Integrated Care models and systems on the NHS involves extensive privatisation.
MPs were asking the wrong questions
The question that MPs on the Health and Social Care Committee needed to ask was:
Why is the government sending huge amounts of NHS money to American and global companies to run the new accountable/integrated care systems behind the scenes?
But they didn’t.
NHS privatisation – hidden in plain sight
The imposition of Accountable/Integrated Care requires spending huge amounts of NHS money in procuring integrated care and population health “support services” from American and global digital technology, health insurance and management consultancy companies.
MPs ignored that and also chose to ignore the fact that new Integrated Care Provider contracts – still currently subject to legal challenge – are a form of lead provider contract.
Meaning that the Integrated Care Provider would hand out many sub contracts to a variety of providers – in many cases to private companies and third sector organisations. This is particularly the case with community care and self care – both key to Integrated Care Systems.
MPs either hadn’t sussed this, or were turning a blind eye.
Rosie Cooper MP (Lab, West Lancs) gave the floor (her words) to Simon Stevens, inviting him to explain to the public that Integrated Care Systems would not lead to privatisation of the NHS, as many members of the public believed.
This was the cue for Stevens’ contemptuous quip that the public was in the grip of a belief
” that’s not shakeable by any empirical evidence.”
Appcock claims “no privatisation on my watch”
Smooth-talking Stevens went on to point out that he had acted on the Health and Social Care Committee’s recommendation last year that the Integrated Care Providers should be public providers and this is laid out in Chap 7 of Long Term Plan.
The Health Secretary Matt Hancock (popularly known as Matt Appcock because of his enthusiasm for turning the NHS into a massive source of profit for digital technology companies) added excitably:
“There’s no privatisation of the NHS on my watch. The Integrated Care Provider contracts will go to public sector bodies to deliver the NHS in public hands.”
This statement was greeted by Rosie Cooper MP with a triumphant
The Chair, Sarah Wollaston, gushed:
” Wonderful. Of course, it was what we recommended.”
“It was based on your recommendations.”
GP-led Integrated Care Providers
Appcock added that, in line with this, they have come up for a way for GPs (which he calls private providers) to “bid in” for an Integrated Care Provider contract through an overarching NHS body that would be a public body.
Prompted by Dr Paul Williams, Simon Stevens agreed that there would be an option for GP and community health services to be integrated in an NHS body without going through the current procurement process.
But in response to Paul William’s question [17.16, Parliament TV video]
“Will there still be a role for non-NHS bodies in delivering NHS care?”
Simon Stevens confirmed that,
“There are ways of doing that that aren’t the inflexible periodical transactional procurement processes that currently operate through the system.”
This seems to directly contradict Appcock’s claim of “no NHS privatisation on my watch”, by affirming that non -NHS organisations could deliver NHS services without even having to go through the current competitive tender and procurement process.
Regardless, Sarah Wollaston said she was glad they’d taken on board the recommendations of the HSC select committee last summer. She asked how they were going to take these proposals forward.
NHS England proposals in February on changes to the law
Appcock said that the NHS has made proposals on changes to the law and
“The Dept of Health is open to potentially making government time available for a bill.”
Simon Stevens said NHS England will put forward proposals in February for legislation and would engage with the select committee and patients groups, the voluntary sector, across the NHS and local authorities.
NHS England wants legislative changes about making Integrated Care Providers able to work jointly with Clinical Commissioning Groups on planning and funding – as well as providing services. There will still be a Clinical Commissioning Groups in each Integrated Care System. Appcock said some of the commissioning responsibility will continue to sit with NHS England.
Simon Stevens also said that very big changes are about to be introduced across General Practice. There would be an announcement soon about a new GP primary care contract. (This was published a couple of days later and requires GP practices to network together to serve 30K-50K population, by this summer. This is intended to help bail out GP practices that don’t have enough staff.
A big change is to be rolled out re outpatients that will change the interface between specialists and GPs. GPs are “becoming focussed on patients with multi-morbidities” ie loads of things wrong with them.
Well we knew that. Basically under the new Integrated/Accountable Care schemes, only patients with complex health problems will get to see a GP. The rest of us will be seen by “allied health professionals” aka the 5 Year Forward View’s “modern workforces” – new, less qualified grades of health workers imported from the USA’s Accountable Care Organisations.
Local engagement processes on integration of primary and community services to start in April
Simon Stevens said “local engagement processes” will kick off in April. They will include “engagement” on the integration of primary and community health services.
Ian Dalton, the NHS Improvement boss, said there is a complex new care model to implement, that has to be done locally and NHS Improvement’s job is to challenge and support that.
An NHS Improvement scheme called “Getting It Right First Time”is going to be extended to mental health, community and primary care services. The scheme currently identifies variations in the way different hospitals provide services. It aims to make them cut costs without damaging patient outcomes and safety.
The NHS Commissioning Board will continue to contract with private companies using competitive procurement
Doctorpreneur Paul Williams (Lab, Stockton South) asked about the role of competition in Integrated Care Systems.
(Bit of background: Para 37 in last summer’s Health and Social Care report on Accountable/Integrated Care comes out in favour of patient choice, and a mixed public/private NHS and social care system as a way to guarantee patient choice. Recommendation 17 was that Accountable Care Organisations should have the freedom to involve, and contract with, non-statutory bodies.)
Dr Williams’ question put Simon Stevens on dodgy ground since he was desperate to claim that the Long Term Plan and its imposition of Accountable/Integrated Care would not increase NHS privatisation – but equally he didn’t want to say the wrong thing about patient choice.
Simon Stevens acknowledged that NHS England (real name: NHS Commissioning Board) contracted for national NHS goods and services using competitive procurement and wanted to go on doing so.
He gave as an example the procurement of Biosimilar Medicines which involved competition between pharmaceutical companies.
Simon Stevens added that NHS Commissioning Board competitive procurement is different from the commissioning process of integrated GP and community health services at local level.
He said that NHS England wanted to give local commissioners the freedom to procure services using best value tests instead of the current 3 year contracts for GP services.
Seemingly finding it hard to square patient choice with the abandonment of competitive procurement of integrated GP and community health services, Simon Stevens rather awkwardly tried to tell Dr Williams that patients will still have a choice of where to access their care, but this choice would not be made possible through local commissioners using the current “periodical transactional procurement processes”.
It was at this point Rosie Cooper rescued Simon Stevens from embarrassment by giving him the floor (her words) to announce that the Long Term Plan has accepted the Health and Social Care Committee’s recommendation that Integrated Care Providers should be public providers.
Other aspects of NHS Long Term Plan
With NHS privatisation hidden in plain sight, the Health and Social Care Committee tripped lightly across other facets of the NHS Long Term Plan.
In answer to Sarah Wollaston’s question about whether there’s the management capacity in the NHS to implement the #NHSLongTermScam, the quangos’ answer seemed to be, search me gov, it’s the local NHS organisations’ problem, not ours.
Capital funding questions
There were questions about capital funding for equipment and buildings, given the backlog of maintenance due to the habit of cash-starved hospitals using capital funding for revenue spending.
Sarah Wollaston MP pointed out that the £2.8bn private finance required by the Naylor Review has been ruled out in the LTP, and asked if that is going to leave a shortfall of £2.8bn?
“We’re clearly going to have to address this in the Spending Review.”
In other words he doesn’t know.
MPs are just nitpicking about technocratic details
The MPs, the Secretary of State and the NHSE CEO apparently all agree with each other about the direction of travel of the NHS under this government and its NHS quangos, and they are just nitpicking about technocratic details – avoiding looking at the real implications of the hurtle towards Accountable/Integrated Care.
While mocking those who disagree with them.