Managed neglect.

The Care Closer to Home agenda, so vaunted as the best thing since sliced bread, at the Meeting the Challenge Consultation, in 2012/13 is being rolled out apace.

The actual Care Closer to Home contract was won by Locala, where the company has increasingly, along with Hospital Trusts, suffered from a staffing crisis and the CCG has said it has recognised it has suffered challenges. But the majority of contracts in England, seem now, to be removed from hospitals. Since 2013, 86% pharmaceutical contracts have been won by non NHS organisations, 83% patient transport contracts won by non NHS organisations, 25% mental health contracts won by non NHS organisations, 76% diagnostic contracts won by non NHS organisations. Where are the costs to patient care being tallied?

Wheelchairs in North Kirklees were outsourced to Opcare. Unless we stop it, the NHS is moving towards a single, inflexible, capitated budget as 44 or so Accountable Care Systems or Organisations. What happens when a budget is capped, is nicely demonstrated by the wheelchair contract. Lauded by the CCG as the best provider for the job, having previously been an expert company moulding prosthetics and devices for disabled people, the company is not able  to fulfill  the expectations of local people who need wheelchairs.  Anecdotally we hear that children with wheelchair needs are measured, but wait so long for it to be delivered, that they have outgrown the chair by the time it arrives. In another case the child is presented with a chair without the necessary straps to regulate the body to a correct posture, so the parents have to resort to tying the child in with string! The company it seems allegedly tells parents it does not have the money to correct these situations. Extrapolate these occurrences over the whole of West Yorkshire including the complete spectrum of health disorders and you begin to get a sense of how damaging to people, a per-capita system will be.

Dermatology referrals, when the GP thinks you may not have a skin cancer but are not quite sure, go to Priderm LLP,  a community business in several GP practices in North Kirklees. Registered with the CQC in 2013, it has not been inspected yet according to the CQC website.  It is another layer of ‘the market’, which comes between a hospital specialist and a GP.  The contract seems to be covering the costs, but it hard to see how it can be cheaper than specialists in a hospital, when you think of the Priderm manager, contract expert, receptionists, venue hire and the cost to the CCG of another contract to assure compliance with. Of course in the future, a receptionist with a list of tick box questions will direct you to this company or not, depending on the criteria on the tick box list.

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