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November 12, 2015

Private Eye Medicine Balls 1343
Filed under: Private Eye — Dr. Phil @ 11:52 am

Hunt’s Choice

In the 31 years since MD first set foot on an NHS ward, there have been a dozen major political disruptions to the NHS. Margaret Thatcher sewed the seeds for an NHS market by splitting it into purchases and providers. Tony Blair’s Labour trebled the budget but also insisted on the ‘constructive discomfort’ of competition. Alas, billions were squandered in paying private providers over the odds ‘to encourage new entrants into the market’ and on PFI deals that are still crippling hospitals today.

The current government’s big idea is to use the global financial crisis as an excuse to starve the NHS and social care system of funding, in the hope that some miraculous better value innovations will rise from the ashes, with the wind of private sector partners beneath their wings. Wary of resistance to privatization in the NHS, the government is using the Trojan horses of ‘integration and collaboration’ to create accountable care organisations (ACOs), which will have budgets for (almost) the entire health and social care of a fixed population, and the entire staffing and administration costs. All the providers within an ACO have to grow up and collaborate fast to ensure patients are treated in the most clinically and cost-effective way. A penny wasted is a penny less to spend on wages.

For patients, treating health and social care as one joined up system makes sense, and it might provide a better service. The experience in America is that ACOs can modestly improve quality but don’t have a huge effect on cost, so they won’t immediately help the NHS make the £22 billion savings George Osborne is demanding. However it does give the opportunity for multinational corporations with experience of running ACOs to win bids in the NHS market. In one fell swoop, a huge chunk of NHS power and money could be transferred to overseas companies driven by shareholder profit.

More urgently, none of the 850 delegates at the recent National Institute for Health and Care Excellence (NICE) conference believed that the NHS can make £22 billion worth of savings without dramatically worsening access to or quality of care. Ged Fitzgerald, the chief executive of Liverpool city council, detailed the staggering levels of poverty and inequality in his city, and said that his entire budget for adult social care will run out in two years’ time. Given this is a statutory service, the government will have to come up with the funding eventually. But why is it putting the NHS and social care system (and patients and carers) through the stress and pain of funding delay?

One answer comes from comparatively affluent Wiltshire, where the chair and accountable officer of the Clinical Commissioning Group (CCG) have written to all GPs to say ‘the financial situation is dire.’ Their predicted funding gap for 2016/17 is £23 million, as the demand for services far increases the funding for them. The only solution will be to ration services and delay referrals. The NICE conference was full of examples of CCGs either illegally rationing NICE approved treatments, or raking up huge debts to provide patients with care they are legally entitled to.
Under huge pressure, Wiltshire CCG has handed over its entire community child health service to Virgin Care. Children’s specialist community nursing, vital and complex child protection, disability and special needs work, health visiting and speech and language therapy will all come under Mr Branson’s umbrella, and staff who wish to stay on will all be reemployed by Virgin care as of April 2016. Will it provide a better service, will it be able to make a 5% profit or will it try and fail?

Overall, the NHS in England has a £960 million overspend for the first quarter of the year, many trusts have ongoing safety issues according to the CQC, most are in debt and 33 don’t have a permanent Chief Executive. The publication of safe staffing evidence has been delayed by the government because Trusts don’t have the money to comply, the retention of student nurses is poor and the retention of junior doctors may will get catastrophically worse if Jeremy Hunt doesn’t see sense over their new contract. With so many Trusts in debt, there is a certain gallows spirit and safety in numbers. Chief Executives barely last a couple of years in the NHS anyway, and most would prefer to go down pissing off the accountants and the Treasury rather than killing patients and being demonised by the Daily Mail. Jeremy Hunt may soon have to make the same choice.

MD’s book, Staying Alive – How to Get the Best from the NHS – is available here