Optum Alliance teaches Harrow NHS and Council Execs about cuts and “complex business systems”

Last year, Harrow Clinical Commissioning Group – part of NW London Sustainability and Transformation Partnership – took part in NHS England’s Commissioning Capability Programme.

Delivered by OptumAlliance (Optum Healthcare Solutions UK together with Pricewaterhouse Cooper), the Commissioning Capability Programme has trained over 55 Clinical Commissioning Groups that NHS England has identified as needing “help” with integrating the local health system in the United Health way.

Harrow Clinical Commissioning Group said it was

“invited to take part because of the financial challenges it is currently facing… The programme will also support the organisation to execute their financial recovery plan.”

In other words, Optum Alliance made sure Harrow Clinical Commissioning Group identified the £20m/year cuts they are going to make.

Whipping Harrow Clinical Commissioning Group into line for the intended merger of all NW London CCGs into one

An intended merger of all eight North West London Clinical Commissioning Groups risks foundering on bickering by wealthier Clinical Commissioning Groups that they are going to have to pay for the Harrow Clinical Commissioning Group’s “deficit”.

The combined NW London system had an overall deficit of £57m in 2018-19 but Harrow Clinical Commissioning Group was £42m in the red while West London finished with a £17m surplus.

How Harrow NHS and social care cuts will be made

Optum Alliance trained Harrow NHS and Council executives to cut NHS and social care costs by:

Building a sustainable strategy – ie cutting hospital services and replacing them with primary care services that will cut costs, and clarifying the role of the new Primary Care Network contract in this strategy.

Financial recovery and planning – Harrow Clinical Commissioning Group faced an annual £20m deficit (ie underfunding). But the Optum Alliance told the Harrow execs that the deficit is caused by too many referrals, too many short stay admissions and too much planned care. So Optum Alliance advice on spending cuts included:

  • How to stop ineffective activities (this is code for so-called procedures of limited clinical value that Clinical Commissioning Groups no longer routinely fund).
  • How the “system” can collectively manage the allocation of money in a key area – such as reducing non-elective admissions of the “rising risk” cohort of patients and speeding up discharge of patients from hospital.

(The “rising risk” cohort of patients is identified through so-called risk stratification of patients. Through analysing patient data, Primary Care Networks put patients into 3 types, each at a different level of risk of unplanned hospital admission. In this Population Health Management pyramid (aka as a Kaiser Permanente pyramid) it looks as if the rising risk cohort of patients is in Level 2.)

Governance – This “advice” seems to be all about how Harrow Clinical Commissioning Group and Harrow Health Community Interest Company (the GP Federation) can get the new Primary Care Networks to carry out the measures OptumAlliance has “advised”, and how (and who) the Clinical Commissioning Group and Community Interest Company need to influence and how to hold people to account.

Implementing and executing – How all the organisations in the Harrow NHS and social care system can agree how to cut costs by the “strategic priority” of reducing unplanned hospital admissions of the “rising risk” cohort of patients.

Managing and influencing – This is about Harrow Clinical Commissioning Group working with Harrow Health CIC, acute hospitals, community services, social care and voluntary sector and the rest of the NW London STP Clinical Commissioning Groups on “model of care and patient pathways” to reduce unplanned hospital admissions of the “rising risk” cohort of patients.

The NW London Sustainability and Transformation Partnership is already strongly involved with Optum, which manages the referrals for the populations of both Ealing and Hounslow.

This is also the Sustainability and Transformation Partnership where Imperial College is located where Mr Darzi (who is also in charge of driving drugs and technology into the NHS) heads the Institute for Global Health and Innovation – which is partnered with OptumLabs. Darzi is of course also on NHS Improvement’s board.

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