What kind of NHS will we have in West Yorkshire come July 1st?

It’s hardly been front-page news, so you may or may not know that from July 1st the government plans to split the English NHS into 42 so-called statutory Integrated Care Systems.

This depends on the UK Parliament passing the highly contentious Health and Care Bill, currently being debated in the House of Lords.

(Update: The 2022 Health and Care Act received royal assent on 28th April.)

A key bit of the Bill is that each of the 42 English Integrated Care Systems is to be run by a statutory Integrated Care Board, governed by its own Constitution. 

In December 2021, Calderdale and Kirklees 999 Call for the NHS responded critically to the consultation on the draft West Yorkshire IC Board Constitution (which has now closed).

On 25 January 2022 CK999 and Leeds Keep Our NHS Public had a virtual meeting with Integrated Care System officials and Leeds Healthwatch to discuss our key concerns – that:

  1. The NHS in West Yorkshire must be comprehensive, universal, free at the point of use and based on patients’ clinical needs – not on the Integrated Care Board’s financial considerations.
  1. The NHS in West Yorkshire must be safely staffed in all service areas, employing all frontline and clinical staff on the basis of national terms and conditions, as in Agenda for Change. All NHS professions will be regulated. Further, the NHS in West Yorkshire will not require “passporting” of staff between places of work where they will have to work with unfamiliar teams. And will not subject staff to further moral injury such as they suffered during successive waves of the Covid-19 pandemic.
  1. The NHS in West Yorkshire must make sure that primary care providers are treated in the same way as NHS Trusts, when the new statutory Integrated Care Boards prepare their five-year work plans and their capital plans. And it will make sure there is continuity of patient care in GP practices.
  1. The NHS in West Yorkshire must halt and reverse NHS privatisation and make sure that the statutory Integrated Care Board commissions NHS organisations – not private companies or charities and third sector organisations – to provide NHS services.

We received little assurance that these issues will be resolved by the West Yorkshire Integrated Care Board’s Constitution.

We are now asking West Yorkshire Integrated Care System to make the following commitments in the statutory Integrated Care Board Constitution

There are a lot of them, which shows how uneasy we are about the lack of clarity from the Integrated Care System that the NHS in West Yorkshire will meet the needs of NHS patients and staff.

These points reinforce the demands made in Calderdale and Kirklees 999 Call for the NHS’s December 2021 response to the consultation on the IC Board constitution.

For patients:

  • We repeat the demand (2.2) made in our response to the draft Constitution response, that the statutory Integrated Care Board will provide a comprehensive, universal, health service free at the point of use for everyone in any “place” (local authority area) within West Yorkshire and the Craven District Council area, whether normally resident or not, based on patients’ clinical needs, not the Integrated Care Board’s financial considerations.
  • So that people can be sure of prompt NHS treatment if they need it outside the Integrated Care System where they normally live, the statutory Integrated Care Board will operate a clear and automatic process of cross-charge /re-charge for patients treated by West Yorks NHS, whose costs as non-residents are not covered in the West Yorkshire resident population Integrated Care Board financial allocation.
  • It will do the same thing for West Yorkshire resident patients treated by other Integrated Care Boards – whether this is as a result of patient choice or of falling ill while temporarily out of W Yorks.

For NHS staff:

  • The statutory Integrated Care Board will stick with national pay bargaining for NHS terms and conditions. 
  • The Integrated Care Board will require regulation for all NHS professions.
  • Staff passporting between employers will be voluntary.
  • ‘Flexible redeployment’ between teams and specialties will be voluntary and largely unnecessary as each team and speciality will be staffed to safe levels.
  • The statutory Integrated Care Board will quickly produce an NHS and social care workforce plan that identifies staffing gaps that are causing the NHS and social care services to fall over and indicates how understaffing is to be sorted out, within a tight timeframe. Priority areas for concrete workforce retention and recruitment planning should include GPs, maternity services, district/community nursing, elderly care and radiology.

For GPs and other primary care providers

  • When it comes to preparing statutory Integrated Care Board workforce and capital plans, GPs and other primary care providers will have parity of influence with Hospitals, and the means of ensuring this will be laid out in the Constitution.
  • The statutory Integrated Care Board will promote continuity of patient care in General Practice, with a clear indication of the means of achieving this goal.

For restoring the NHS as a publicly funded, provided and run service

  • The statutory Integrated Care Board will clarify what commissioning functions and powers the existing West Yorkshire  Provider Collaboratives already exercise, and whether/how this will change under the statutory Integrated Care Board. (As the WYAAT provider collaborative director Lucy Cole has blogged,  “The new Health and Care Bill recognises provider collaboratives as a key system component.” What will WY Provider Collaboratives’ roles be within the West Yorkshire Integrated Care System?
  • Given the Integrated Care System’s decision to not appoint private providers to the statutory Integrated Care Board and its committees, the Constitution should clarify that ‘private providers’ include APMS GP contract holders, since large companies, such as Modality and the Centene subsidiary Operose Health, hold multiple GP contracts.
  • The statutory Integrated Care Board and its “place” (local authority area) commissioning committees should prefer NHS providers and given them priority over private companies when awarding contracts.
  • The Constitution should specify the statutory Integrated Care Board refuses the Health and Care Bill’s proposal that contracts can include discretions in relation to anything to be provided under the contracts. 
  • NHS providers will not be allowed to advertise private providers or direct patients to them.
  • The Constitution should clarify whether existing contracts with private providers in “place” will simply be rolled over,  once the requirement for competitive tendering and 3 year market testing of contracts no longer applies, and if not how these contracts will be procured.

Plus, since the Integrated Care System’s Director boasts of the System’s influence with NHS England and the Department of Health and Social Care, we are asking him to ask those bodies to exempt NHS providers in the West Yorkshire Integrated Care System from applying the hostile environment NHS charges, for reasons of public health and NHS staff’s professional promise to “First, do no harm.”

This is the letter we sent to the Integrated Care System folk after the meeting. It includes our full requests for what the statutory Integrated Care Board constitution should specify, in order to meet our four key concerns:

Comments on key points of the meeting

Q: Will West Yorks NHS provide a comprehensive, universal service free at the point of Use for everyone with a clinical need?

The Integrated Care System said that it is an Integrated Care System duty under the Health & Care Bill to promote or provide a comprehensive, universal NHS – ie without excluding any services or patients. (There was a difference of opinion between Integrated Care System officials about whether this duty is to “promote” or “provide”.)

But under our questioning, it emerged that the statutory Integrated Care Board will only be funded to extend this duty to the population who are “normally resident” in West Yorkshire (and Craven District Council area). 

There was no clarity about the “mechanics” for claiming back payment for non-resident patients treated in W Yorks NHS, from the statutory Integrated Care Board where they’re normally resident and which is funded to treat them. 

And vice-versa, for how West Yorkshire statutory Integrated Care Board would repay other statutory Integrated Care Boards that treated West Yorkshire patients who needed or chose to access treatment outside West Yorkshire. 

The Integrated Care System officials had no awareness of the possibility that – as seen last autumn in Greater Manchester – urgent care might be refused to a patient resident in another “place” (local authority area) than the location of the service they’re trying to access. There was no clarity about whether the Constitution would make sure that this doesn’t happen in WY Integrated Care System.

The Integrated Care System officials claimed that no services would be excluded from the Integrated Care Board’s “core responsibility” – but admitted that NHS Dentistry effectively denies care to many NHS patients, as the NHS as a comprehensive universal service doesn’t work for NHS dentistry.

And there was no recognition that across England many GPs’ electronic portals were directing patients to private companies where they would have to pay for diagnostic tests. 

Even though Integrated Care System Director Ian Holmes acknowledged,  “That doesn’t sound right”,  there was no commitment to ban GPs and other NHS providers from advertising private services in this way.

Will West Yorks NHS be safely staffed?

The Integrated Care System was not aware of any of the issues we raised about safe staffing, but nonetheless claimed to have a good relationship with “staff side” (trade unions) and to be consulting with them throughout the process of setting up the statutory Integrated Care Board and its Constitution.

Will GP and primary care workforce planning have parity of influence with ICS workforce planning for hospitals and other services? And will the IC Board promote continuity of care for GP patients?

The Integrated Care System only offered platitudes on these questions.

Will the statutory West Yorkshire Integrated Care Board halt and reverse NHS privatisation and make sure that the Integrated Care Board commissions NHS organisations to provide NHS services?

Self-congratulatory claims were made in the meeting about the “exceptionalism” of W Yorks Integrated Care System, in terms of its decision not to appoint private providers to the statutory Integrated Care Board and its delegated committees. 

The self-congratulation seems to be unwarranted.

The Constitution’s definition of private providers does not include GP Alternative Provider of Medical Services contract- holders. This means representatives of big companies, such as Modality or Centene’s UK subsidiary Operose Health, could be members of the statutory Integrated Care Board and its committees, making commissioning decisions.

The Constitution doesn’t exclude charities and community interest companies from membership of the statutory Integrated Care Board and its delegated committees – thus holding open the door for continued soft privatisation of the NHS and philanthocapitalism. 

(For example, the alliance between the Richmond Group of health charities and  New Philanthropy Capital, which took to pushing Social impact bonds as the means of funding socially-prescribed services for the old, fat, poor and mad as a key part of Sustainability and Transformation Partnerships/Integrated Care Systems, with Somerset Sustainability and Transformation Partnership as the testbed.  Social impact bonds are seen by their advocates as a means of making the voluntary sector more “resilient” by providing a secure source of finance for a number of years. More info here: Social impact bonds – a kind of Private Finance Initiative scheme for NHS and social services in deprived areas )

Just like private providers, if 3rd sector organisation can’t make money, they hand back to contract or go broke. One to One Midwives, a private, for profit company, contracted by the NHS in Liverpool, ran out of money and shut up shop, leaving pregnant women in the lurch. In July 2019 a children’s hospice in Bury run by the charity Forget Me Not, had to close because it’s broke. This is the trouble with leaving vital services to be run by charities and voluntary section organisations – which NHS England intends will happen more and more, in a move back to the Victorian era.

The Integrated Care System Officials were unable to commit to making the NHS the IC Board’s preferred provider.  All the Integrated Care System Director could say was that the policy framework was moving away from competition to “a collaborative between statutory partners in place… including NHS providers, Local Authority and the place reps of the Integrated Care Board coming together and saying, how do we spend this money?” He thought “This emphasis on partnership will kind of facilitate that sort of model.”

But it seems unlikely that there will be any reduction in NHS privatisation, once place based commissioning is carried out the the Integrated Care Board’s “place” committees. 

Local authorities such as Calderdale Council have long since privatised nearly all their public health, community health and social care services – including the CAMHS online service Kooth, funded by Root Capital private equity investor.  

And NHS providers in “place” are also privatising their services. For example, Somerset NHS Foundation Trust has contracted Rutherford Diagnostics to provide a Community Diagnostic Centre (CDC) in Taunton. The press release from Rutherford Diagnostics partner Philips Health UK states,

“In addition to providing services to NHS patients, the centre will be available to private medical insurance and self-pay patients in the South West.”  

The ICS Director said that by removing the requirement for to market test contracts every 3 years (was that ever really a requirement?), the Integrated Care Board and its “place” Committees “won’t have to spend a big chunk of time responding to tenders and that will help build those relationships in place.” We need to know if that applies to the many existing contracts with private providers? Will they be permanently cemented? 

If you’d like more info about the meeting, you can download our Record here:

3 comments

  1. I’ve fwd it to both my local groups and highlighted the fact we also did the draft constitution request some months ago.

    Suggested we follow suit with you. Hope that’s OK

    Steve X

    On Sun, 13 Mar 2022, 19:18 Calderdale and Kirklees 999 Call for the NHS, wrote:

    > Green__Jenny posted: ” It’s hardly been front-page news, so you may or may > not know that from July 1st the government plans to split the English NHS > into 42 so-called statutory Integrated Care Systems. This depends on the UK > Parliament passing the highly contentious Health ” >

    Like

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