This is a look at 2 of the papers for the 3rd Feb 2021 Lancs and S Cumbria Integrated Care System Board meeting:
- The “longer term financial challenges” for Lancashire and South Cumbria system, p40
- The quarter 3 update from the Health Infrastructure Plan 2 (New Hospitals Programme), p46. Of course it came out before the DHSC Sec of State’s recent order to stop the upcoming consultation on Preston/Chorley hospital services redisorganisation – which the Sec of State has now sidelined in favour of the New Hospitals Programme. This will see either two new hospitals to replace the Royal Preston and Royal Lancaster Infirmary, or a single hospital to serve the whole of Central and North Lancashire. More info here from Jenny Hurley, admin of Protect Chorley and S Ribble Hospital Campaign
And a commentary on the privatisation risks of the Health Infrastructure Plan 2
If you have any problems accessing the papers on the S Lancs and Cumbria Integrated Care System website, you can download them here:
“Financial challenges” – ie £300m funding shortfall in 2021/2
Lancs and S Cumbria Integrated Care System faces around a £300m funding shortfall in financial year 2021/2.
The Integrated Care System doesn’t know how to make “savings” (cuts) so that they can “balance the budget” as NHSE/I requires them to.
They have to agree “baseline contract values” that “align” with the available funding (which is £340m less than needed for 2019/20 levels of provision to continue).
So they are talking about how to run a “deficit” and what NHSE/I might permit.
“10. So how might we think about setting our own targets for improvement? [ie Cuts] Would we wish to be more ambitious in the short term or build up to a larger savings [Cuts] target in future years? Would we have a choice? Where should we look for savings? [ie Cuts] What is possible? Do we know where we have opportunities? Should savings be required from all parts of the system e.g. primary, secondary and tertiary care, physical and mental health services? Can we avoid service reductions, given the scale of the financial challenge that we have, or is there still the opportunity to achieve savings through efficiencies? [They define efficiency as “our ability as a system to be able to offer the same services for lower cost. For example, higher throughput per session in theatres; fewer agency and locum staff; lower staff sickness levels; obtaining the best prices for consumables and equipment; reduction in costs for back office functions; etc “]What about the need to catch-up on elective services post Covid? Surely this will require more, not less resources?
A £300m deficit reduced to zero over three years = £100m (2.7%) savings a year and over 5 years = £60m (1.6%) per annum. L&SC has never managed an absolute reduction in the amount spent on health services. These facts illustrate the huge challenge facing our system.”
Health care the Integrated Care System thinks it can cut
They think they can cut £113m Clinical Commissioning Group costs by reducing patient referrals to these services:
And £154m cuts in these hospital treatments
They say they can’t add the £113m to the £154m, because there are overlaps between the two categories of spending cuts eg Cardiology/circulatory diseases feature strongly for both CCGs and providers.
So they need to find around another £150m cuts on top of these.
It seems that they are expecting NHSE/I to tell them what to cut
“34. The system will probably not be invited by NHSEI to determine its own savings trajectory over a longer period of time, but that should not stop us thinking about what we may wish to aim for and it does not stop us from starting to develop a programme of the savings we can make.”
Health Infrastructure Plan 2 (New Hospitals Programme) update
This has a tight timeframe. NHSEI requires a 12 week public consultation throughout October – December 2021/22. So by October 2021, the Integrated Care System has to come up with the pre-consultation business case, including an evaluation of options. They then have to submit a decision making business case sometime in January-March 2022. (para 2.3)
3.4 – The Trusts must obtain governor support for the transaction. So need to inform public governors about what’s going on.
Looks as if any semblance of local democratic control over NHS redisorganisations is being stamped out
NHSEI and the DHSC are in charge – tt’s very centrally controlled.
“4.1 A series of discussions have taken place with the national team at NHS England/Improvement (NHSE/I) and the Department of Health and Social Care (DHSC). Together they are centrally managing all schemes in the HIP (New Hospitals Programme) across the country.”
So it’s unlikely that the Lancashire and Cumbria Joint Health Scrutiny Committee will have any power over the proposal.
Combine this with White Paper proposals (5.84) to:
- remove the power/duty of Councils’ Health Scrutiny Committees to refer proposals that are not in the interest of local NHS and public;
- abolish the Independent Reconfiguration Panel and
- give the Secretary of State the power to intervene early in redisorganisation proposals.
In the meantime, several sources in the region have told the Health Services Journal that until the White Paper becomes law,
“ministers can effectively get their way by threatening to make life difficult when it comes to capital funding for bigger projects.”http://bit.ly/YourMoneyOrYourConsultation
In other words, drop the Central Lancashire Our Health Our Care consultation or forfeit the New Hospitals money.
The national control of the project (and the very tight schedule) are clear from the paragraphs about how ‘the national team’ wish to move forwards together:
- “4.3.1 The Lancashire and South Cumbria scheme will take place 2025 onwards.
- 4.3.2 We are to prioritise the first 3-6 months of 2021 to progress feasibility work, improving digital readiness and thinking about the future sustainable operational model.4.3.3 Progress work to define the clinical need and demand projections against a standard set of assumptions ensuring thought is given to the building solution best suited to deliver this.
- 4.3.4 All market engagement with construction contractors is to be aligned via the national team.
- 4.3.5 All external communications are to be agreed with NHSEI and DHSC prior to publication.
- 4.4 A ‘round-table’ meeting is anticipated in January/February 2021 (date TBC) to clarify the scope of the programme and its deliverability. This will be attended by representatives of NHSEI (regional and national) and DHSC. Work is underway to prepare for this and to identify attendees.
The Health Infrastructure Plan is about the total redisorganisation of the NHS, at primary care and community health care levels as well as hospitals
“5.2 the Health Infrastructure Plan published by the Department of Health and Social Care in September 2019 discussed how “NHS infrastructure is more than just large hospitals. Pivotal to the delivery of more personalised, preventative healthcare in the NHS Long Term Plan is more community and primary care away from hospitals. That requires investment in the right buildings and facilities across the board, where staff can utilise technology such as genomics and Artificial Intelligence (AI), to deliver better care and empower people to manage their own health.”
But presumably just to confuse us all,
“5.5…the Lancashire and South Cumbria HIP programme…will now be renamed the New Hospitals Programme.”
The move of community and primary care away from hospitals is a huge privatisation opportunity
Campaigners have been banging on about this since the announcment of Sustainability and Transformation Plans all those years ago – and particularly in Lancashire with the award of big community health service contracts to Virgin Care.
Lancashire Virgin Care NHS contracts include Adult Community and Urgent Care Services, Skelmersdale Walk In Centre, and Healthy Young People and Families Service – awarded by Lancashire County Council despite a Judge’s ruling that taking the £100m contract away from the two Lancashire hospitals that had previously provided the service threatened
“the disruption and damage to the provision of the whole range of healthcare”.
The full extent of this “privatisation opportunity” is only just now becoming apparent: in at least some places, patients will have to follow entirely privatised treatment “pathways”, from primary care through community health referrals to hospital treatment. Attention has been focussed on this as a result of the recent USA Centene Corporation takeover, via one of its UK subsidiaries Operose Health Ltd, of around 34 Alternative Provider of Medical Services GP contracts in London with patient lists of 375K patients.
Lancashire’s many Alternative Provider of Medical Services GP Practices are key to this “privatisation opportunity”
The Centene Corporation/Operose Health takeover of the GP surgeries in London was possible because they are Alternative Provider of Medical Services contracts.
There is a very high number of APMS practices in Lancs, which puts them at risk of takeover by big corporations like Centene Corporation/Operose Health.
Introduced in 2004 by the New Labour government as a way of opening up GP practices to private companies of any description – control of Alternative Provider of Medical Services contracts can be changed with written authorisation from the NHS Commissioners.
But the authorisation process followed by the 13 London Clinical Commissioning Groups and NHS England has been opaque and appears deeply flawed.
Lancashire and South Cumbria Integrated Care System Health Infrastructure Plan 2 is making links with other HIP2 schemes
PWC and ETL are brokering these links for the Lancashire and South Cumbria Integrated Care System HIP2 programme team. At what cost to us taxpayers?
“a multi-disciplinary team with expertise in Property, Healthcare Strategy + Planning, Cost Management, Programme Management, Project Management and Sustainability.”
The other Health Infrastructure Plan 2 schemes that the paper mentions (para 7.6) are Leeds Teaching Hospitals and University Hospitals of Leicester. The paper adds,
PWC and ETL have established networks of other schemes… Over the coming period, discussions will take place with South Devon and Torbay and the Cornwall schemes.”
The list of HIP2 hospitals is here (p22-23)