Increased funding that commercialises our NHS will damage individual and population health – demand more #NHS4All funding!

Call to Action!

#ActLocalThinkNational – please support the #NHS4All demands in your local campaigns! You can do this by sending our full demands (listed below) to your Sustainability and Transformation Partnership/ Integrated Care System. They are now preparing their 2019-2024 operational Five Year Plan, to submit to NHS England by 27th September. More info about this here. Please also send the demands to your MP, local newspapers, Councillors’ Health Scrutiny Committee etc. And find out as much as you can about your Sustainability and Transformation Partnership/ Integrated Care System 2019-2024 operational Five Year Plan.

This blog post explains the reasons for our #NHS4All demands.

A blog post about the CONTEXT for our #NHS4All demands is here. Please check it out if you’ve not already.

These are the #NHS4All campaign demands:

• Much-needed further increases in NHS funding – both for the NHS Mandate (ie the services provided by the NHS England) AND other key Department of Health budgets – which are NOT included in the NHS Long Term Plan funding settlement.
• The government write-off of all the NHS Organisations’ deficits that have accumulated over the last nine years, as a result of sustained government underfunding of the NHS.
• Proper public consultation on the Sustainability and Transformation Partnerships’/Integrated Care Systems’ 5 year operational plans – and an end to the pretence that local Healthwatch organisations are in any way competent to seek the required “local approval” for the plans.

ALONG WITH an end to:

• The dismantling of our NHS into fragmented accountable/integrated systems/providers – that force local NHS organisations to clear their “deficits” that were incurred through a decade of damaging underfunding, while siphoning £millions of NHS funding to private companies and charities.
• The hugely wasteful marketisation and privatisation of the NHS. An updated NHS Reinstatement Bill [link] must be passed that restores the NHS as a comprehensive, universal #NHS4ALL – properly publicly funded, free of all privatisation and marketisation and directly accountable to the Secretary of State with a duty to provide and promote its services.
• Corporate fingers in the NHS pie and the revolving door between the NHS and corporations.

THESE ARE THE REASONS FOR OUR DEMANDS

We are the sixth richest country in the world. We can afford a properly funded NHS and social care service

As the sovereign currency issuer, the government can create money – just as it did to bail out the bankers to the tune of at least £1trillion, after their unregulated greed wrecked themselves and the global economy in 2008. Writing off the NHS Organisations’ deficits that have built up as a result of years of underfunding would be a much more socially useful and economically productive use of this power.

Nearly 10 years of brutal underfunding of the NHS – and all other public services – has been based on Osborne’s austerity policy. This was a political choice not an economic necessity – and it’s killing people.

This political choice is used as a justification for the financialisation of the NHS – running it as a business, not on the basis of meeting patients’ clinical needs.

Despite the government’s “extra” funding for the NHS Long Term Plan, the NHS Quangos are tightening the financial screws on local NHS organisations – more info here.

The extra NHS funding is not enough to make up for nearly a decade of damaging underfunding – more info here.

Tighter financial controls and corporate profiteering are reducing patients’ access to NHS health care and worsening population health.

The “extra” goverment funding for the NHS Long Term Plan is to feed corporate profits – while simultaneously shrinking the NHS to 44 local Integrated Care Systems by April 2021. (These are the successors to the 44 Sustainability and Transformation Partnerships.)

These Sustainability and Transformation Partnerships/ Integrated Care Systems function as if the NHS is a business driven by financial considerations, not patients’ clinical needs.

They incentivise clinicians to “manage demand” for treatments, by allowing them to keep some of the contract money that they don’t spend on patients’ care. (The rest is shared with the NHS commissioners – so-called aligned incentives.)

Jean-Pierre Unger and Pierre De Paepe have analysed the effects of such commercialisation of health services (resulting from health insurance commoditization).

Their research confirmed the hypothesis that commercial health care insurance reduces patients’ access to professional health care and worsens population health.

Although their research concerns the inefficiency of the US, Dutch and Swiss healthcare systems, its findings are transferable to the NHS as it adopts market-based financial models identical to those used in the USA and elsewhere.

Right now, NHS Sustainability and Transformation Partnerships/Integrated Care Systems are adopting market-based financial models in shadow form. In other words, NHS and Local Authority commissioners and providers are setting up and using a commercial insurance-based model within the NHS shell. The “managed care” provided by commercial health insurance is being imposed on the NHS – just without commercial health insurance companies – so far.

(They are doing this under the instruction of Optum – a healthcare services subsidiary of USA global healthcare company United Health.)

There is no reason to expect that the negative impacts of managed care on the NHS will be any different from the effects Unger and De Paepe’s research identified in the USA, the Netherlands and Switzerland. Indeed we can already see them happening in NHS Sustainability and Transformation Partnerships/Integrated Care Systems.

The research identified the main negative impacts of “managed care” on care quality as:

• tight constraints on physicians’ professional autonomy (and so ethics)
• a large reliance on the physicians’ material motivation
• health service fragmentation
• the tendency to apply evidence-based medicine too rigidly

All these detriments are already apparent in the NHS Sustainability and Transformation Partnerships/Integrated Care Systems.

Financial controls on NHS organisations rest with non-statutory Integrated Care Systems

The NHS Long Term Plan assigns financial control powers typical of those held by commercial health insurance companies to Integrated Care Systems. And all Sustainability and Transformation Partnerships must become Integrated Care System by April Fools Day 2019.

The quango NHS England/NHS Improvement are forcing tighter controls on both Clinical Commissioning Groups’ and hospitals’ spending – and it has delegated the power of enforcing them to the non-statutory Integrated Care Systems.

We strongly object to this financialisation of the NHS – running it as a business, not on the basis of meeting patients’ clinical needs. And with non-statutory enforcers, that have no legal existence.

Turning the NHS into a business means clinicians have to put the bottom line above their duty of care to patients

Clinicians are increasingly faced with the requirement to limit operations and interventions and to stick to a strict refusal of prescriptions for items that can be bought over the counter, regardless of the effect this has on patients on low incomes.

Clinicians – particularly in primary care – are being forced to make decisions on the basis of financial concerns. This is against a backdrop of obscene amounts of money being spent on the redesign of the NHS, that destroys NHS core principles of universal access to comprehensive services based on clinical need. All under the costly instruction of OptumAlliance.

A clinician says,

“All I hear is that this will save sparse resources and sustain a future NHS. Not many are challenging the money being diverted into the redesign of our NHS, which will end up as profits for private health companies, digital technology and life science companies.
The worst is, as clinicians our focus should surely be the person in front of us and their needs. That’s where our duty of care should rest. Yet we have been brainwashed over time that to protect the individuals we must think of the bigger picture so our focus is diverted from where it should be. Let’s concentrate more on & prioritise the individual before us and to hell with phoney economic arguments that turn the NHS into a business rather than a health service.”

If the NHS Long Term Plan is carried out, those who are too poor or ill to pay will have to make do with an increasingly limited range of NHS services, modelled on the USA’s Medicare/Medicaid system. Those with money will pay to go private.

Increasingly NHS hospitals are seeking to cater for private patients. This is driven by shrinking NHS funding for a growing range of elective operations, growing waiting lists, overcrowding in cancer wards and lack of investment in vital diagnostic equipment – which the new London Mayo Clinic/ Oxford Uni/Oxford hospitals trust private diagnostic clinic at 15 Portland Place is taking advantage of.

Private companies are profiting from setting up surveillance medicine that is a civil liberties nightmare

The NHS Long Term Plan is embedding surveillance medicine in GP practices, in order to further “manage demand” for NHS services in ways that profit private companies.

Surveillance medicine is effectively turning the NHS into a digital panopticon. (This was originally a system of social control where all inmates of prison can be observed by a security guard, without them being able to tell whether they are being watched).

All the better to cut costs, create opportunities for new corporate “entrants” into the NHS, and introduce conditionality into the NHS – just as it has already destroyed what used to be social security.

To turn the NHS into a system of surveillance medicine, NHS England has created a Health Services Support Framework .

This lists companies authorised to sell NHS commissioners the skills and software required to analyse patients’ confidential GP records and identify those deemed to be at risk of costing the NHS a lot of money.

Under the new Primary Care Network contract, NHS England is paying GPs to make sure that the potentially high-cost patients identified through analysis of patients’ confidential GP records, hook themselves up to wearable technology and submit to remote monitoring and participation in behaviour change schemes – such as NHS England’s Diabetes Prevention Programme.

These behaviour change schemes are cash cows for private companies.

For example, NHS England’s Diabetes Prevention Programme is provided by 5 private companies:

• Ingeus
• ICS Health and Wellbeing (Independent Clinical Services, based in Leeds)
• WW (the new Weight Watchers)
• Reed (in a joint venture with Momenta)
• Living Well Taking Control (in partnership with Live healthcare)

Update 7 March 2023 – Current providers of ‘NHS’ Diabetes Prevention Programme

It seems the Healthier You NHS Diabetes Prevention Programme Providers have changed since the programme was set up. The current NHS England webpage lists these providers:

• Xyla Health and Wellbeing (part of the Acacium Group)
• Living Well Taking Control
• Reed Wellbeing
• Thrive Tribe

End of update

Each Sustainability and Transformation Partnership /Integrated Care System has to have one of these companies running the Diabetes Prevention Programme in their area.

According to the Memorandum of Understanding the private companies are required to make sure that GPs refer a specific number of patients to them for assessment.

This is basically NHS England pimping out GPs to private companies. What happened to doctors’ autonomy and their duty of care to patients?

And then there is the little matter that a British Medical Journal article has rubbished the idea that individual behaviour change schemes such as the Diabetes Prevention Programme can work as a preventive strategy.

It is all the most fantastic scam.

Update 8 Dec 2022

Earlier in the year, Lancashire and South Cumbria NHS organisations awarded a new contract to Reed Wellbeing to continue the National Diabetes Prevention Programme service across the Integrated Care System area. Reed Wellbeing is part of the Reed Group, a large recuruitment company, and a a subsidiary of Reed in Partnership, one of the Reed Group companies and a self-described ‘leading provider of public services.’

Update 1 March 2023

Analysis carried out by University of Manchester researchers appears to show that pre-diabetic patients who participated in the NHS Diabetes Prevention Programme (part of the NHS Right Care Diabetes Pathway) had a 20% lower risk of progressing to diabetes, compared to when compared to similar patients not referred to the NHS Diabetes Prevention Programme.

However, it sounds like a pretty useless study in a number of ways. First, the researchers’ conclusions are grossly exaggerated in comparison with their findings. They say,

“Our findings support the decision of the rapid large-scale implementation of the programme in England, rather than a slower or regional introduction, but also support the continuation of the programme and the introduction of similar programmes to the rest of the United Kingdom (i.e., Northern Ireland, Scotland, and Wales).”

But although the confidence intervals for both groups don’t overlap, at the extremes they are only 1.1% apart. In other words, there could well be only a 1.1% difference between the groups – not the 20% the researchers claim:

“The probability of not converting to T2DM at 36 months since referral was 87.3% (95% CI: 86.5% to 88.2%) for referred to NDPP and 84.6% (95% CI: 83.9% to 85.4%) for not referred to NDPP. “

While that finding is statistically significant (i.e. valid), it’s not clinically significant – i.e. it’s not important enough to make a big deal about.

Second, what strikes me as weird is that the researchers say they examined the impact on patients of referral, rather than attendance or completion of the Diabetes Prevention Programme.

So it’s as if just being referred made the difference, rather than participating in the behaviour change programme.

The researchers acknowledge that their focus on the evaluation of referral rather than attendance or completion is a major limitation to their work – and so is the observational nature of the study, which does not allow them to establish causality.

Companies on NHS England’s Health Services Support Framework

This is why we must slam shut the revolving door between government and corporations and get corporate fingers out of our NHS pie

One of the chief companies on NHS England’s Health Services Support Framework is Optum, a subsidiary of United Health – the former employer of the NHS England/NHS Improvement boss, Simon Stevens.

In addition to contracts gained through NHS England’s Health Services Support Framework, Optum is also being paid £millions by NHS England to go round the country with PwC . This so-called OptumAlliance is training Clinical Commissioning Groups in how to turn their STPs into Integrated Care Systems – which is compulsory by April 2021.

PwC also has a clear conflict of interest. On the one hand it’s advising NHS Commissioners to introduce surveillance medicine, on the spurious grounds that this will cut the costs of acute and emergency hospital services through improving individual and population health. On the other PwC also tells its corporate clients that these wellbeing and behaviour changes schemes are a great opportunity for new private company entrants to the NHS. (As NHS England’s Diabetes Prevention Programme shows.)

The NHS needs more money – but not to feed corporate profiteering from public services

The NHS needs more money. That we can surely all agree on, after nearly a decade of punitive underfunding that has almost brought the NHS and its staff to their knees.

But huge sums – estimated at between 4%-10% of NHS funding – are wasted on the costs of NHS privatisation and marketisation. Stopping and reversing that through the NHS Reinstatement Bill would mean about as much extra money available for patient care as is promised by May’s new funding increase.

It’s not surprising that influential privateers clustered around Lord Darzi, Lord Prior and the Blairite think tank, the Institute of Public Policy Research, ignore the wasteful transaction costs of NHS privatisation.

Instead they see inadequate funding as one of the “barriers to reform” – “reform” being the implementation of NHS England’s 5 Year Forward View – and now its end game, the NHS Long Term Plan.

According to the influential 2018 Darzi report, published by the Institute of Public Policy Research, this call for increased funding for things like robotics and artificial intelligence, the internet of things, big data, and cell and gene therapies:

“There is a huge risk that without a long term funding settlement and plan, the health and care system will not be able to invest in new treatments and technologies…”

The May government apparently listened, according to Harry Quilter -Pinner, a senior research fellow at the Institute of Public Policy Research. He tweeted at the Report’s launch:

“Jeremy Hunt himself has been recognising it as influential in getting a better deal for the NHS.”

Who paid for Darzi’s influential report that shaped the government’s NHS funding decisions? Life Sciences companies and big health charities are calling the shots

These are the Report’s Corporate sponsors:

Check them out:

• Gilead – an American biotechnology company that researches, develops and commercializes drugs.
• Baxter – a Fortune 500 American health care company “delivering transformative innovations that bring smarter, more personalized care to all of us…”
• CF (Cystic Fibrosis Trust) A charity that lobbies NHS England to pay for their precision medicine products.
• MSD aka Merck & Co. HQ in NJ, USA – “a top five global pharmaceutical company”.
• Siemens Healthineers: A German medical technology company

Their ‘investment’ in the Institute of Public Policy Research Report has paid off. The “extra” NHS funding is going into exactly those sectors that the Report called for. CK 999 has reported on this here and here .

It’s a massive rip off. The rocketing costs of the medical innovations and drugs these sectors produce is a key reason for the escalating cost of running the NHS. But it’s rarely mentioned. It’s easier to blame the old, fat and mad for making excessive demands of our NHS.

And things can only get worse if Brexit leads to a UK trade deal with the USA that removes the NHS’s ability to control the prices it pays for a whole range of vital drugs and medical innovations.