Integrating Care proposals are not in best interests of Devon Patients

Save Our Hospital Services Response to NHS England Consultation ‘Building a strong integrated care system’ 8 January 2021

Save Our Hospital Services has reviewed the proposals set out in the document Integrating Care and concluded that they are not in the best interests of patients in Devon. They do not represent an efficient use of taxpayers’ money, or provide a secure, sustainable foundation for the National Health Service in the future. They are not in line with the founding principles and values of the NHS.

Our full response to the consultation is downloadable here:

The main points are these.

  • This is an exercise in minimising NHS spending and rationing public health services, at a time when the priority should be building capacity to meet the challenges of the future.
  • Claims that existing Integrated Care Systems – such as Devon’s – show improvements in patient care are not evidence based. Independent clinicians have pointed to a complete lack of evaluation or follow up of patient outcomes.
  • The closure of highly successful health hubs in community hospitals has damaged joined up working in our region. Joined-up working is promoted by trusted professionals being given the space, support and resources to work together, at a local level.
  • The plan for ICSs is not focused on improving care for patients but on binding NHS organisations through financial controls and centralised plans.
  • We welcome the implied admission that the internal market in NHS services has been a disaster, but these new proposals risk outsourcing ever larger contracts, potentially to private bidders, so that only the largest players will be able to enter the new NHS market.
  • The NHS now needs to be properly re-integrated under the governance of Parliament and the Secretary of State for Health, reversing all the provisions of the failed 2012 Health and Social Care Act and removing entirely the competitive market and the purchaser-provider split.
  • The disaster of Covid-19 has been made worse by reliance on privatised services that have never approached the efficiency and value provided by the NHS services. The primary lesson is that profit-making organisations must never again be allowed to siphon funds away from our public health sector, and should be locked out of providing NHS care as soon as existing contracts can be terminated.
  • These proposals seek to embed ‘population health management’, using population-based budgets with incentives for reducing costs, and segmentation of risk – all features of insurance-based systems, in which large US corporations dominate.
  • The NHSE Health Systems Support Framework (HSSF) strongly prioritises financial savings over patient needs. The HSSF is designed to implement systems of patient and data management such as those needed for insurance-based systems and population risk management, rather than to establish clinical priorities. The majority of companies accredited through the HSSF are major corporates, including many involved in health insurance in the US and elsewhere.
  • This is not how the NHS was conceived and not what made it the most efficient healthcare system in the world. We demand an NHS that is free from profit, free at the point of need, publicly accountable, and securely funded through general taxation.
  • Joined-up working across primary, acute, community and social care has nothing to do with the governance and budgeting arrangements for these services and everything to do with trusted professionals being given the space and support to work together, at a local level. Professionals need no ‘incentives’ to collaborate in the interests of patients. They need pay and conditions that reflect their expertise, and encourage them to remain in post for the years it takes to build strong local networks.
  • The NHS is already unnecessarily complex and local people feel ignored in decisions about their services. Merging CCGs into larger bodies, alongside PCNs, further reduces local accountability.
  • Far from creating seamless collaboration, there is the potential for conflicts of interest as clinicians take charge of how NHS budgets are spent across primary, acute, social and community care.

3 comments

  1. The NHS will function via genomic hubs and informatic centers integrated for predictive health and precision care with many able to stay at home while recovering. Not to integrate care and state it is not in the tax payers interest is a gross miscalculation and apathy on what the future holds for personalized care and patient safety. Extremely short sighted on the vision for genomic medicine and the right artificial intelligence. Some may argue that these decision are led by resistance fractions to improve patient safety. Remember the oath to do no harm. To block integrated care is to cause harm.

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    • Well out of my depth here but surely using the genetic make up of a patient is an additional tool available to the doctor in diagnosing and treating his/her patient.It is a part of the whole process and does not require reorganisation of the entire NHS which actually was an integrated national health service. Seeing cost savings often highlighted alongside genomic medicine may attract politicians but may not lead to better diagnosis and treatment of the patient. As GPs are pushed further into long term care of the elderly, the disabled and chronic conditions it is the delivery of high quality basic care and rehabilitation which needs to be given priority.

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    • I’m not sure what you’re saying James Andrew Henry but it seems that you’re criticising Save Our Hospital Services’ response to NHS England’s consultation on the grounds that it advocates blocking integrated care. If so, I think you’re making a straw man argument. SOHS are careful to say they’re not opposed to integated care, and they understand that to be properly based on the free actions of clinicians and others working with, and in the interests of, patients. In disagreeing with NHSEngland’s proposed ICS legislation, they are of the view, backed up with their own observations and experience of the cuts imposed by Devon Integrated Care System, that these proposals are NOT about effective clinician-led integration of services in the interests of patients – but a means of imposing cuts and damaging centralisation of services and wasting a lot of public money on the extraction of corporate profits from the NHS funding stream. There is a discussion to be had about genomics-informed personalised care, but this doesn’t feel like the place to hold it. Meanwhile, there is this to be going on with. https://calderdaleandkirklees999callforthenhs.wordpress.com/2019/12/05/us-companies-optum-and-mckinsey-are-driving-nhs-genomics/

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