Northern Care Alliance to take over Liverpool University Hospitals’ specialist surgery for intestinal failure

Liverpool University Hospitals Foundation Trust has apparently not been selected as one of the reduced number of hospitals to continue to provide specialist surgery for intestinal failure, despite scoring highly in the tender process run by NHS England.

This is because the the Northern Care Alliance – headed up by Salford Royal Hospital, a national centre for intestinal failure surgery – was able to bid for surgical services in Cheshire and Merseyside, where it already provides some services, as well as those in Greater Manchester.

The Northern Care Alliance was most recently in the news for a protocol that denies patients care if they seek NHS treatment in a hospital that’s not covered by their “place” care organisation.

Formed by Salford Royal NHS Foundation Trust’s acquisition of Pennine Acute Trust, the Northern Care Alliance Foundation Trust is forming a partnership with a US integrated care organisation, University of North Carolina Health.

The US care organisation is funded by a mix of public money from the Medicare and Medicaid insurance systems for people who are too poor or ill to pay for private healthcare, and private insurance money.

According to the Northern Care Alliance Chair – a former employee of the University of North Carolina – this public/private model is the future for the Nothern Care Alliance.

The Health Service Journal has reported the Chair as saying that the partnership with University of North Carolina Health will allow the Northern Care Alliance to learn

“…what some of the funding challenges are in that blended model of public money through Medicare and Medicaid and private insurance money…we’ll look at building more corporate and commercial partnerships…England is moving … to … a system where more and more of the public will have some private healthcare insurance.”

When the New Labour government’s NHS Act 2006 created NHS Foundation Trusts as public benefit corporations, the amount of income they could earn from private patients was capped at 2%. The 2012 Health and Social Care Act raised this limit to 49%. That means reduced capacity for NHS patients. From the Chair’s statements about “blended” public and private insurance money, increased income from private patients – with associated reduction in capacity for NHS patients – would seem to be where the Northern Care Alliance Foundation Trust is headed.

Now the Northern Care Alliance is at the centre of a controversy about an “unfair” tender process in which NHS England is withdrawing specialist surgery for intestinal failure from multiple hospitals

According to the Health Service Journal, the British Society of Gastroenterology has flagged concerns that NHS England’s “scoring process [to select the hospitals] may not have been entirely fair” and has called for an independent review.

NHS England plans to reduce the number of hospitals providing surgery for intestinal failure from 40 to 11, with around 22 hospitals (including the surgical centres) expected to host non-surgical intravenous feeding services.

As well as telling NHS England of concerns about its unfair scoring process, Alastair McKinlay, president of the BSG, has suggested the tender process also took the wrong approach by focussing on surgical care first, saying it is the provision of intravenous feeding which is “crucial for the care of the vast majority of IF patients”.

He said the expected loss of surgery at some hospitals was leading to a reduction in staff and destabalising entire departments, which could mean some are unable to host intravenous feeding teams.

The Health Service Journal has reported Dr McKinlay as saying it was “completely understandable” that clinicians from the two national centres (Salford and St Marks Hospital in north-west London) were involved in the design of the tendering process, but that putting the emphasis on surgical services “probably gave them an advantage”. He said allowing the national centres to compete with regional units had created a perception the process was “unfair”.

The Health Service Journal added that the Northern Care Alliance/Salford Royal said it did not wish to comment, but did say none of its clinicians were involved in designing the procurement or tender process for the North West region. LUFT did not respond.

Felicity Dowling of Save Liverpool Women’s Hospital said,

“The public has had no notification of this, and even active campaigns had no knowledge. Such decisions should be open to public scrutiny, not a decision reserved to NHS bosses be they medical or administrative.”

Mary Whitby from Save Ormskirk and Southport Hospitals added,

“This will mean all those other hospitals losing the ability to train surgeons properly. Giving a handful of centres a monopoly & ability to say we are all overloading the NHS – rather than them shrinking it.”

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