A retired Newcastle Hospital Trust consultant and manager who walked from Jarrow to London on the People’s March for the NHS as penance for his part in dismantling NHS services through outsourcing, told me that Board Papers could easily be written to conceal the effect of any proposal.
“It’s what you leave out, that’s important” he said. “When people raise questions later, you just show them where they’d signed off the paper.
Rob Webster , the WYSTP Chief Executive,says that the new contract for the ACS will commission for ‘outcomes’ and leave the operational patient pathway, to the ‘organisations’. (Those who control the patient pathway control the NHS said a very senior member of the NHS I know of).
What outcomes? Outcomes that matter to patients? Or to bean counters?
The new MSK Musculo Skeletal Contract that North Kirklees has awarded to Connect Health http://www.connecthealth.co.uk/ has a glowing write up on the CCGs website. What outcomes is the CCG commissioning for?
We can hazard a guess, since the West Yorkshire and Harrogate STP Right Care Value Pack https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2016/12/west-yorkshire-stp.pdf shows MSK as a ”headline opportunity” – the service with highest “opportunity” for cutting spending.
(Although this is questionable, since recent research published in the Journal of Public Health concluded:
“RightCare promises illusory savings based on an inappropriate fixed comparator group and faulty statistics…If RightCare is used to justify savings in NHS budgets, it is acting as a cover for cuts.”)
What patients actually get from Connect Health, is a phone call following referral, to arrange a telephone triage within a couple of weeks. In that, symptoms are described and some people tick enough boxes to get offered excercise sheets plus, if they want,…a physio appointment with several weeks wait. After 3 months an appointment comes through for a physiotherapist, who is employed by MYHT and uses a completely different set of exercises to what is on the Connect Health sheet.
This seems to me, money for old rope for Connect Health. It also looks like a stepping stone on the way to doing away with GPs.
If N Kirklees commissioned Connect Health for the outcome of reducing physio referrals to MYHT, all the company would have to do is raise the bar high enough so that very few people qualify.
Priderm for dermatology, is another company slipped in between the GP and the Hospital. Also there is an intermediate contract for opticians practices in Wakefield so that instead of GPs referring to A&E for urgent eye cases, patients have to ring round to find an optician with a vacancy that day! All this outsourcing costs money over and above the treatment given.
CCG Governing Bodies papers for other areas show that the Social Care sector has been putting pressure on CCGs for more money. In a fixed budget, ‘managed market’ as the ACS would be and which would include private care companies – as the Wakefield Care Homes Vanguard MCP already does, with 25% of Care Homes backed by Hedge Funds, there is a worry that public money will be used, out of public view, hidden by commercial confidentiality, to prop up failing businesses.
In the USA, the biggest cause of death after Heart Attack and Cancer in 2014, was avoidable medical error. Commercial confidentiality allows providers to get away with this. Companies will not open up their ‘pathways and procedures’, to the doctors trying to find what had gone wrong. In the scramble for profit, many things are skimped on.
At least two aspects of the role of ACSs and ACOs make them unfit for the West Yorkshire and Harrogate NHS, and the public:
a)Handing control of the health service to private companies in pursuit of outcomes that have little to do with patients’ needs
b)Reducing health and social care services to match inadequate funding with the mantra ‘self care.’
This seems like a sick joke in society where the working poor can’t afford to eat nutritious food or are lucky to rent dry houses with no black mould growing on the walls, and have to live on a tiny wage in insecure jobs that reduce them to cogs in a machine.
Psychological and non-communicable ill-health has become the hallmark of this profit-driven economic system; inequality, which is linked to ill-health, has grown to levels unseen since the nineteenth century.
Promoting self care is an evasion of responsibility for public health.
Please scrutinise the ACS proposal carefully.