Optum gets 3 Somerset and Wiltshire Clinical Commissioning Groups to work as one and make cuts

Call to Action – this is an #NHS4All campaign post

If you want to act on the information in this blog post, here are some things you can do:

*PROTEST to your local paper, MP and Councillors about the fact that NHS England told your local NHS Commissioners to attend training with the huge American healthcare services company Optum, in order to learn how to import Optum’s business practices into the NHS. These are based on making clinicians cut costs in order to increase health insurance company profits. Is this how we want our NHS to be run? As a business, not a comprehensive, universal health service where treatments are based on patients’ clinical needs, not financial considerations? You can see here that this has already made it impossible for GPs to fulfill their duty of care to patients. How much worse is it going to get once Optum has completed its dirty work all over our NHS?

*ASK your local Joint Health Scrutiny Committee to call in the Bath and NE Somerset, Swindon and Wiltshire Clinical Sustainability and Transformation Partnership 5 Year Plan, that is to be produced this autumn. Because NHS England says these 5 Year Plans have to be “locally approved.” (NHS England also says this is the job of Healthwatch, but that’s a joke). The 5 Year Plan proposes signficant changes to the local NHS – some are outlined below. It is the job of the Joint Health Scrutiny Committee to decide if proposals for significant changes are in the public interest.

Last year, Bath and NE Somerset, Swindon and Wiltshire Clinical Commissioning Groups 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 way of United Health.

This huge American health services company is the former employer of the CEO of NHS England and NHS Improvement, Simon Stevens.

NHS England “invited” the Bath and NE Somerset, Swindon and Wiltshire Clinical Commissioning Groups to take part in the Commissioning Capability Programme so that Optum could bang heads together about “whole system working and commissioning at scale”- ie at the level of the Sustainability and Transformation Partnership.

Begging the question of what local services would be cut in order to centralise them

The aim was to make commissioners jump through hoops in time to become an Integrated Care System by 2020.

The Optum Alliance advice led to the following “outcomes” for the BaNES, Swindon and Wiltshire CCGs.

Integrated “commissioning at scale” across Bath & NE Somerset, Swindon and Wiltshire Sustainability and Transformation Partnership

Update 10.12.2020 – checking some info here today, I found that some links to key documents no longer exist. Luckily I had saved them so I’m replacing the now non-existent links to BeNES, Swindon and Wiltshire CCGs websites with links to the downloadable documents.

To get this started they formed a Bath & NE Somerset, Swindon and Wiltshire Commissioning Alliance which called a joint confidential meeting of the 3 Clinical Commissioning Groups on 4 Oct 2018. The meeting agreed to appoint a single Accountable Officer and Management Team (incorporating the Sustainability and Transformation Partnership) for all three Clinical Commissioning Groups – noting:

“This would not preclude consideration of a formal merger of the CCGs at a later stage.”

Here’s where you can download the document recording the 4th October 2018 joint confidential meeting of the 3 Clinical Commissioning Groups:

Re not precluding consideration of a formal merger at a later stage – you bet! In June 2019, the 3 Clinical Commissioning Groups agreed to apply to become a single organisation by April 2020. A local news report noted that the BaNES, Swindon and Wiltshire STP has to make £70m cuts/year.

To create a single Accountable Officer and Management Team (incorporating the Sustainability and Transformation Partnership), the 3 Clinical Commissioning Groups have adopted a model constitution from NHS England. (The model constitution was prepared on behalf of NHS England by thiNKnow LTD with the support of Browne Jacobson LLP.) It contains provisions for collaborative commissioning arrangements, as well as for joint commissioning with local authority partners, other Clinical Commissioning Groups, and NHS England.

The model constitution sounds dodgy in that it allows for amendments to the Clinical Commissioning Group Constitution, without Membership and NHS England approval.

It also removes the statutory functions and duties of the Clinical Commissioning Group in accordance with the 2006 Act from the Constitution. (1.12, Paper-11-wccg-constitution-changes-to-support-bsw-commissioning-alliance – downloadable above.) CK 999 doesn’t know what this means, but it sounds weird.

We think it may be so that the Constitution remains valid if the proposed Primary Legislation for the NHS Long Term Plan includes removing the statutory functions and duties of the Clinical Commissioning Group in accordance with the 2006 Act.

Financial planning and recovery – ie cuts

As a result of the Optum Alliance advice”, the 3 Clinical Commissioning Groups are including reductions in length of stay in the Financial Recovery Plan as “there are significant savings to be made”.

By 30 June 2019 they were to develop a delivery plan for the reduction of length of stay. And the three Clinical Commissioning Groups were to understand how the future way of working would “impact on their own financial position and that of the system, to contribute meaningfully to a sustainable financial strategy.” In other words, spending cuts.

One year on – BaNES, Swindon and Wiltshire Integrated Health and Care Strategy

A key outcome of the Optum Alliance “advice” to the 3 Clinical Commissioning Groups is the BaNES, Swindon and Wiltshire Integrated Health and Care Strategy.

This is clearly based on Optum Alliance advice.

It is the basis for the region’s Five Year Plan, to be produced in Autumn 2019.

And it aims to set up an Integrated Care System in 2020, that will move care out of hospitals and “other bed based locations” into people’s homes.

Primary Care Networks that include voluntary and community services will be the main means of doing this.

3 Integrated Care Alliances to be set up with Local Authorities

The Bath and North East Somerset Integrated Care Alliance includes “local health and care organisations” in Bath and North East Somerset. Note that they don’t call them NHS and care organisations. This is because the Integrated Care Alliance includes private and voluntary sector companies and organisations.

There are also Swindon and Wiltshire Integrated Care Alliances.

The Bath and North East Somerset Integrated Care Alliance Board consists of:

  • B&NES Clinical Commissioning Group
  • Avon and Wiltshire Mental Health Partnership NHS Trust
  • B&NES Council
  • The Royal United Hospitals NHS Trust
  • Virgin Care – which has the community health and care services contract with both the Council and the Clinical Commissioning Group
  • Healthwatch and representatives from primary care (GP staff) and the voluntary sector (link coming soon about Social Impact Bonds)

Social Impact Bonds are a financial instrument designed to generate money to invest in 3rd sector-run public services for “underserved communities” – ie making a buck out of the poor and ill – and return a profit to the investors.

The Richmond Group of health charities and New Philanthropy Capital have been pushing Social Impact Bonds as the means of funding socially- prescribed services for the old, fat and mad – a key part of Sustainability and Transformation Partnerships/Integrated Care Systems.

Update 28 May 2021

Bath, North East Somerset, Swindon and Wiltshire ICS is asking private providers for cash to fund System running costs

The Health Service Journal reports that

  • Bath and North East Somerset, Swindon and Wiltshire Partnership asked private provider to contribute £10,000 a year
  • Senior responsible officer Tracey Cox says fee is not compulsory but covers ICS running costs
  • Contributions to be included in this year’s financial budget

Well-placed sources have told HSJ that the Bath, North East Somerset, Swindon and Wiltshire ICS recently asked a private provider to contribute £10,000 a year to the system for 2021-22. It is understood to be asking other independent providers in the area too.

Tracey Cox, BSW Partnership’s senior responsible officer, told HSJ  the annual contributions are “voluntary” and go towards general ICS running costs.

It is understood providers’ contributions will be included in the 2021-22 budget and they have been told the money will “fund a number of roles and initiatives that support system work programmes”.

Some other providers — thought to be NHS trusts — are already contributing almost £100,000 each annually to the ICS’ running costs.

Ms Cox told HSJ: “As a new partnership, and one that brings together more than a dozen of our local health and care system’s key players, we inevitably face some running costs and these have, since the time of the former BSW Sustainability and Transformation Partnership, been supported through voluntary contributions by a number of our member organisations.

“These contributions are in no way contractual, nor a pre-requisite to membership, with a significant proportion of these contributions going towards the funding of system-wide initiatives which benefit all partner organisations.”

ICS are due to become statutory organisations in April next year, if proposed government legislation is successful, at which point it is they will receive their own allocated budget.

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