This is the latest update on the petition STOP the plans to dismantle our NHS, posted on 14.5.2020. Please consider signing the petition if you’re not among the 32K+ who already have.
In my area at 8 o’clock last Thurday, the biggest noise ever for the NHS and carers echoed along the valley, as car horns and firecrackers joined the clapping. People were not clapping for NHS England and Improvement. Nor were they clapping for the Director of my Integrated Care System (aka Accountable Care). They were clapping for NHS doctors, nurses medics and all the other support staff in our hospitals and care homes.
Yet on 11 May, 4 new Integrated Care Systems were announced by NHS England/Improvement. They are Hertfordshire and West Essex; Humber, Coast and Vale; South West London; and Sussex. All four were previously sustainability and transformation partnerships, with Sussex and East Surrey STP becoming Sussex ICS. East Surrey has joined the Surrey health system.
Followers of this petition will remember that the sustainability and transformation partnerships were identified as Accountable Care Systems, until it was decided that the name was too descriptive of the US model of healthcare and were known as being accountable for the money, not to patients. The name was changed to Integrated Care Systems and they have powers handed on from NHS England, even though they are not a statutory body, and have no status in law. NHS England wants all areas in England to be fully functioning Integrated Care Systems (ICS) by April 2021 as set out in the NHS Long Term Plan. Instead of being put ‘on hold’ these plans are racing ahead under the lockdown conditions, out of sight and any sort of scrutiny and at speed. This includes even redesigning the redesign in London. This came out last week:
“As we go to press The Lowdown has also seen a letter from NHS England’s London Regional Director Sir David Sloman, sent out internally on April 29 but not published, requiring Integrated Care System Chairs and Senior Responsible Officers to take “urgent action” on system plans for London that “fundamentally change the way we deliver health and care.”
Each ICS is ordered to supply a “revised ICS plan” by Monday May 11. The letter spells out a 12-point list of issues on which bureaucrats in each area are supposed to devise new policy, on the hoof, for a “Recovery Board” meeting on May 13.”
Where London leads everywhere else follows?
What’s the problem? The ICS are supposed to ‘Integrate’ health, provided by publicly run NHS and outsourced bodies, with Council-organised Social Care and Public Health. Indeed our CCG stated at an ‘engagement’ meeting in public in February that it was having great success.
The test is, what’s happening on the ground? Hospitals beds are still closing in London and community hospitals elsewhere and instead, beds are being commissioned in hotels in Devon, Calderdale and no doubt in other places.
In the middle of March 2020 NHS England mandated that patients in Hospital Trusts throughout England and all STPs and ICSs, should be quickly discharged to recover in Care Homes in order to free up hospital beds for people with Covid 19. I have found no reference to ICS or councils being consulted about this, I’m sure you will let me know if that was the case.
Care homes are not nursing homes and staff do not have the training in infection control that is present in a Hospital Trust. Nor do home care employees. There was a potential for rapid spread of any infection. Directors of Public Health employed jointly by Public Health England (PHE) and Local Authorities sit on all the relevent ICS committees in my area and should know their patch. But Public Health England did not empower them to track and trace the contacts of people who tested positive for the virus, in Care Homes or anywhere. Directors of Public Health wrote to NHSE to ask for NHS 111 data about symptoms in their area. That does not seem to demonstrate ‘Integrated’ to me.
On 1st May PHE wrote to them to tell them about “design work for the public health contact tracing operating model that is being undertaken at great pace and set out the thinking for future roles”. They now have responsibility to track, trace and quarantine contacts and patients in Care Homes. Why only there?
Meanwhile in London, the new plan is to use jaunty rhetoric of a “post-Covid NHS” to distract attention while NHS bosses covertly consolidate changes that have been accepted with minimal discussion to deal with the Covid crisis, but which would be controversial as a permanent arrangement. Scrutiny is urgently needed.
And it’s not just London bosses raring to go to implement new changes. STP Chair for Norfolk and Waverney Patricia Hewitt has said,
“A national framework is required but it must be locally delivered within integrated care systems as that it the only way it will work and take account of the different ways of working.”
She said any solution would have to involve “some quite difficult conversations” about what health and care responsibilities citizens should manage themselves.
The complications around a different post-Covid 19 health status indicate that some people will be needing extra support from health services in the future.
Maybe they won’t get it under the new super ICS arrangements. ICSs are accountable for the money. The Government’s definition of NHS, is public funding stream. Who benefits? Funding goes to the ICS where there are contracts with a variety of Public and for-profit providers, through the Local Authorities in the patch and Clinical Commissioning Groups and Hospital Trust networks. It includes knit-your-own-NHS Universal Credit style personal health budgets, which our CCG is talking of rolling out to more people. From where I’m looking, my ICS doesn’t look successfully ‘integrated’ or fit to deliver its stated aim of improving population health.
Please sign and share. https://you.38degrees.org.uk/petitions/stop-the-plans-to-dismantle-our-nhs
Stay safe and well.