Cuts, privatisation and next-to-zero democracy: the real story behind #Calderdale and Huddersfield #NHS and social care strategic review

The example of what’s already happening with Cambridge and Peterborough Clinical Commissioning Group’s “Integrated care for the elderly” contract has to be one of the strongest arguments against Calderdale and Huddersfield NHS Foundation Trust’s proposals for reducing hospital beds, closing Calderdale A&E and integrating health and social care in the community.

The CHFT Strategic Review, and the related Better Care Fund Submission documents, make great play of their proposals for integrated, patient-centred care in the community.

But look at what’s happening with a near-identical proposal in Cambridgeshire and Peterborough.

Cambridge Stop the NHS Sell Off has successfully challenged Cambridge and Peterborough CCG for acting unlawfully, by failing to allow opportunities for meaningful public engagement in the tender of the £800m contract for integrated care for the elderly.

David Lock QC, who was instructed by Cambridge Stop the NHS Sell Off,  said the case showed that CCGs face conflict between commercial confidentiality and public engagement.

He said:

“This tension must be resolved in favour of openness because those are clear legal obligations which have been imposed on the CCG by Parliament.

“It is not possible to run the NHS like Tesco’s supply chain where everything is kept commercially confidential.”

Alliance contracting – like Public Private Partnerships for NHS and social care services

The Cambridgeshire and Peterborough CCG contract for integrated care for the elderly is an example of alliance contracting. This new form of contracting is likely to become common in the stealth-privatised NHS that the 2012 Health and Social Care Act has created.

An article by staff at Candesic, a management consultancy that advised the Department of Health on the £200m sale of our publicly-owned Plasma Operations to Bain Capital, says alliance contracting is overhauling the NHS ecosystem:

“…great progress has been made in bringing the free market into the NHS…and…greatly increased the private sector’s involvement with (and income from) the NHS.”

Alliance contracting, initially developed to set up North Sea oil operations, involves a prime contractor and a bunch of subcontractors. The Candesic article says that in alliance contracting, aka prime contracting, Clinical Commissioning Groups invite:

“expressions of interest from prime contractors who then take over responsibility for services, often to a defined population, negotiating themselves with sub-contractors where necessary…the CCG are effectively passing the risk of looking after a segment of the population onto providers, in some cases private providers.”

The Candesic article continues to bang on about risks associated with alliance contracts, and how the CCG passes on the risks to the Prime contractor and the provider/s. In this context “risk” is code for justifying the extraction of ridiculously big profits, as happened with PFI and PPP contracts for building hospitals and community health centres such as Calderdale Royal Hospital and the five Semperian PFI community health centres in Kirklees.

The private PFI contractors extracted profits way above the kind of profits that they would normally have gained, by claiming that they bore the risks associated with constructing and running the buildings. Thus leaching much-needed public money out of the NHS.

The Candesic article explains that alliance contracts, like the Cambridgeshire and Peterborough CCG contract for older people’s care -worth £800-900m over 5-7 years,

“are ‘all you can eat’ contracts where while funding is fixed, demand is open ended”.

Hmm, what does that sound like a recipe for? Screwing the patients, to my way of thinking.

“Demand management” and personal budgets

And indeed the word is that “demand management” will be an important aspect of the proposed integrated community health and social care services in Calderdale and Huddersfield.

And another word is that “personal budgets” will also be an important aspect of the new contracts. As in, you get a certain basic minimum in a “personal budget” and if it’s not enough to pay for the services you need, you have to top it up out of your own income.

Which begs the questions:

  • What happened to the commitment to an NHS that is universal and free at the point of need?
  • What happens if you’re poor?

Meanwhile, private companies will be sucking public money out of the NHS and social care system.

Now I think I need to go and lie down in a darkened room for a while.

Please come back soon for Part 2 of Cuts, privatisation and next-to-zero democracy: the real story behind Calderdale and Huddersfield NHS and social care strategic review.We’ve barely scratched the surface so far.

In the meantime, you could read about Cambridge Stop the NHS Sell Off

(The Candesic article about how alliance/prime contracting is “overhauling the NHS ecosystem”,mentioned above, is by Dr Druin Burch and Dr Leonid Shapiro, in HealthInvestor October 2013.)

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