#NHS Not all Privatisations are equal, some are worse and some are Evil…
In 2012, the then Coalition Government of Chuckle Brothers; David Cameron and Liberal Democrat, Nick Clegg, put into legislation the Health and Social Care Act.
- This is an edited copy of a submission by @pamos19 (twitter) and Calderdale and Kirklees 999 Call for the NHS to the Integrated Care System consultation.
- Reproduced under the terms of the: http://creativecommons.org/licenses/by-nc-sa/3.0/*
This insidious bill — which has been completely overlooked by the British Media — removed for the first time since the NHS’s creation in 1948, the duty of the Sec of State in the provision of a comprehensive, universal NHS that is free at the point of clinical need which is publicly funded, owned, managed and delivered by NHS staff.
You have to rewind to September 2010, 4 months into the Coalition Government’s unfortunate life, to find three representatives of the huge American health insurance company United Health attending a lobbying meeting which the then Secretary of State for Health, Andrew Lansley, gave to the Commissioning Services Industry Group. Six months later United Health refocussed its UK business to concentrate solely on commissioning support in areas such as:
- Data analytics
- Demand Management
- Medicines Management
Stating this could play a key role in helping the NHS make £20bn in: “Efficiency savings”.
The Austerity agenda of the Coalition Government, of a privatised NHS commissioning, was clear from the start…
The United Health connection became more apparent when Simon Stevens, former CEO of the Medicare business of the world’s largest health insurance company…you guessed it…United Health (2020 revenue, $251.08 bn) and President of its Global Health division, as Chief Exec of the NHS Commissioning Board, set up the secretive Commissioning Support Industry Group — chaired and funded by, you guessed it…United Health. In 2016, the Group drew up an approved suppliers list (Lead Providers Framework) for a £3bn — £5bn privatisation of Commissioning Support Units, with United Health as the lead provider for nearly all the Commissioning Support Units.
In 2018, the ‘NHS Commissioning Board’ replaced the Commissioning Support Lead Providers Framework with the ‘Health Systems Support Framework’. The new Framework’s explicit function is to provide the “support services” needed to get Integrated Care Systems up and running. Specifically: “digitisation of services and the use of data to drive proactive population health management approaches across Primary Care Networks (PCNs) and integrated provider teams.”
In this way, NHS Commissioners are already required to pay private companies to do the work for them, of setting up and using a commercial insurance-based model of healthcare provision, within the NHS shell of Integrated Care Systems. The Conservative Government now wishes to cement this privatisation through proposed legislation to abolish Clinical Commissioning Groups and hand their strategic commissioning functions to a new statutory corporate NHS body — that is basically the Accountable Care Organisation previously proposed by the Department of Health and Social Care, before they decided to abandon the name in an attempt to shed its American connotations which campaigners had drawn attention to.
*The official Whitewash explainer of ICS. Note not a single mention of American Healthcare to be seen anywhere…*
Jobs for the boys…
Simon Stevens proposed legislation would exempt private companies from competition rules and regulation and would almost certainly to establish United Health’s subsidiary: ‘Optum’ as anear-monopoly provider of the strategic commissioning functions of Integrated Care Systems…
Optum would be handed the power of deciding what NHS and Social Services should be provided, when and how and to whom. Optum’s commissioning processes are already entrenched in the NHS as a result of “invitations” by NHS England to scores of Clinical Commissioning Groups to work with Optum and to adopt their insurance-based, cost-cutting commissioning processes as the basis for turning Sustainability and Transformation Partnerships into Integrated Care Systems.
A statutory corporate NHS body model that additionally brings CCG statutory functions into the I[ntegrated] C[are] S[ystem]” is basically an Accountable Care Organisation...
The claims made — in terms of providing a greater incentive for collaboration and clarity of accountability across systems, to Parliament and to patients — are misplaced to the point of dishonesty.
Turning Integrated Care Systems into Integrated/Accountable Care Organisations, would enable American health insurance and digital technology companies (which dominate the supplier lists in the Health Support Services Framework) to take up near-monopoly positions running the NHS. Thanks to years of groundwork, they are now poised to do, if this proposed legislation is enacted and this proposed legislation is the end game of at least a decade’s steps towards the privatisation of NHS Commissioning.
We have seen from the Conservative Government’s response to the Covid-19 pandemic, that the corrupt and secretive handing out of £bns of public money to companies — often with financial and personal connections with the Conservative Party — has resulted from the emergency suspension of requirements to publicise contract opportunities so that companies are able to bid freely for them.
A similar process could easily result from NHSE/I’s proposal to abolish the requirement for competitive tendering of contracts. ‘Collaboration;
is a very nice buzz word, liberally scattered throughout the: Integrating Care Next Steps document. If Matt Hancock is going to be handing out contracts to private companies, doing this in the absence of competitive tendering is wide open to abuse, as we’ve seen with the Covid-19 contracts.
Far from increasing accountability to patients, privatising NHS Commissioning and putting it in the hands of US companies would undermine accountability to patients and endanger clinicians’ ability to practice evidence-based medicine, where treatment is decided on the basis of dialogue between clinician and patient about the best option in the patient’s individual circumstances…
The establishment of Sustainability and Transformation Partnerships, and their development into Integrated Care Systems, has already introduced actuarial processes into NHS commissioning, by American companies eager to pursue the profits to be gained from from the massive guaranteed NHS funding stream — and in particular from access to the unique digitised treasure of over 70 years’ worth of a whole country’s personal medical data. Confidential medical data is already being widely shared with these companies, as they embed methods of controlling spending by identifying individual patient costs to the NHS.
Effectively the proposed legislation would seal the degradation of the NHS from a comprehensive, universal public service that’s based on meeting people’s medical needs (not on our ability to pay), into a state-funded business where access to health care is driven by actuarial considerations.
This so-called ‘managed care’, imported from the USA’s Medicare system, is a way of cherry picking patients whose treatment offers the ‘best value for money’ and denying the rest of us access to treatment — or making it conditional on participation in behaviour change schemes, largely run by social enterprises or private companies.
So much for increased accountability to patients.
You are a Barcode…
Barcoding patients to track their costs to the NHS Patient Level Information Costing Systems — which are central to Integrated Care Systems/Organisations — are another threat to accountability to patients.
Patient Level Information Costing Systems require:
- Mental Health
- Ambulance Services
To cost the care individual patients receive, by combining healthcare activity information with financial information in one place. Each resource that the patient uses, is recorded and costed — eg staff time (in ward minutes), drugs and diagnostic tests etc. Patient Level Information Costing Systems requires finance and clinical teams to work together to embed the use of individual patient costing as business as usual.
NHSE/I’s Approved Costing Guidance 2020/21, tells providers what integrated information they need to collect in order to provide Patient Level Information Costing Systems data to their business intelligence dashboards, for “effective local reporting, with outputs that can be used as part of the decision-making process at regular intervals.”
This is approach is central to the Accountable/Integrated Care Model. Clinicians have been clear that prohibiting treatment options on the basis of financial restrictions undermines their duty of care to their patients. It is certainly not going to increase their accountability to patients or to their own ethics.
Population Health Management…
The other key aspect of this actuarial integrated data collection, is Population Health Management, which involves commissioners:
- Identifying cohorts of high-cost patients.
- Risk stratification, based on linked personal medical data from hospitals, GPs and other providers,
- Dividing NHS patients into high, medium and low risk groups which correlate with the cost of the treatments they receive.
United Health’s subsidiary Optum already uses this “risk stratification” system to assess patients for America’s privatised insurance-led system.
In 2019, NHSE paid Optum to go round the country running 20 week Population Health Management courses for 4 Integrated Care Systems in Leeds, Dorset, Berkshire and Cumbria & S Lancashire.
The 20 week ‘Optum’ course for Dorset was about how linking and analysing data is used to: “influence the behaviour of professionals delivering care and individuals managing their own lives”. It involved Optum:
“taking what integrated data was available and working with emerging PCNs to implement change in the management of a locally determined cohort of patients.”
In Leeds, Optum basically supplanted the statutory Leeds Clinical Commissioning Group and Leeds City Council commissioners by:
- Redesigning care for the frail elderly
- Providing actuaries and population health analytics to the Leeds commissioners’ business intelligence team.
They want your data…
To share and “build on the experience of data sharing during COVID”.
The existing legislation is entirely clear:
‘if there’s a lawful basis and legal duties (e.g. of care and confidentiality are met, then data can be shared. If not, then it can’t’
The data sharing during COVID has been so lacking in transparency and accountability that it took the threat of legal action, supported by thousands of citizens, before NHS England published the contracts it had struck with tech firms to deliver the Covid-19 data store. Open Democracy are now considering a judicial review to compel the government to hold a full public consultation before it awards a longer-lasting data store contract after the pandemic.
The proposals for more flexible legislation to build on Covid-19 data sharing, would increase NHS dependence on private tech companies in a way that would essentially make it digital tenant to a global corporate landlord. We Lina Dencik, the co-director of the Data Justice Lab at Cardiff University, has warned that:
“As a natural monopoly, once the NHS is locked into such a relationship it is unlikely to be able to extricate itself”.
Additionally: The proposed legislation would cut access to NHS treatments on the basis of actuarial judgements, divert a large part of the NHS funding stream into private profits and irrevocably hand control of NHS commissioning and the data sharing it depends on to global corporations.”
(Calderdale and Kirklees 999 Call for the NHS)
The legislation proposes other than mandatory participation of NHS bodies and Local Authorities, membership should be sufficiently permissive to allow systems to shape their own governance arrangements to best suit their populations needs?
What we are looking at is the disintegration of our NHS rather than integration: ‘bodies’; ‘systems’; and ‘own governance’…
Under the guise of ‘best suit their population needs’ the ICS proposals will create a post code lottery. These systems prioritise and encourage business
opportunities and profit making. The Accountable Care Model, which the Integrated Care System is, operates within a *fixed* budget and minimally requires balancing the books but ideally requires a profit to be made. This requirements leads to cost-cutting and restriction of services which would then be offered as a ‘pay for’ service, provided within the ICS as an option.
*If one ICS has a population which eg has an unexpected and unaccounted for health crisis, there will be a restriction imposed on another, normally free under NHS treatment/service such as elective surgery. Whilst a neighbouring ICS, unaffected by the health crisis, would still be providing the treatment.*
The NHS should never be corporatised and the terminology used by the NHSE quango currently clearly demonstrates that it has been.
Are but a few examples.
By implementing the ICS legislation the Conservative Government would give the green light to fully immerse our health and social care provision in the world of business and profit.