Government  (trying to wash its hands of unpopular hospital closures) likes to say it’s all about local decisions now, but funnily enough Calderdale’s local decisions look a lot like local decisions everywhere else.

Across England, NHS Trusts and Clinical Commissioning Groups are “reconfiguring” and “transforming” NHS and social care in very similar ways.

In South West London, the proposed changes – which the Clinical Commissioning Groups have withdrawn following widespread public protest – go by the Asda-sounding title Better Service, Better Value.

In Calderdale and Greater Huddersfield, they are called Right Care, Right Time, Right Place (apparently plagiarising the 1980s Martini ads “Anytime, anyplace, anywhere”).

Calderdale and Greater Huddersfield NHS bureaucrats say that their proposed changes are the result of the clinical judgments of local health professionals, and that they also give the public what they have said they wanted in extensive consultations.

But in fact the proposals follow a lot of cental diktats, heavily influenced by pro-privatisation think tanks.

The national strategy for “integrated care for patients and populations”, produced by the pro-privatisation health policy think tank The Kings Fund, underpins NHS reconfiguration proposals across England.

Calderdale and Greater Huddersfield’s reconfiguration proposals also follow NHS England commissioning guidelines called Right Care/Commissioning for Value. These guidelines are strongly promoted by the NHS Commissioning Board (the body which Clinical Commissioning Groups are accountable to), Monitor, (the body responsible for seeing that Clinical Commissioning Groups stick to competition rules), influential pro-privatisation health policy think tanks The Kings Fund and Nuffield Trust, and the management consultants, McKinsey.

 Pushing a new business model for Big Pharma

The proposed transformation of NHS and social care seems set to benefit Big Pharma’s new business model, more than patients. And it’s likely to intensify the over-prescribing and over-treatment that are a major cause of NHS costs inflation – one of the issues Calderdale and Huddersfield NHS bureaucrats use as a justification for their cost-cutting “case for change”.

Big Pharma, urgently seeking a new business model, since patents on many of its most profitable drugs are due to expire soon, is driving a global transformation of health and social care that aims to replace costly hospital care with cheaper healthcare in a “third place”.

This “third place” is neither the hospital nor the GP practice, but wherever the so-called “superconsumer” patient happens to be.

Big Pharma is looking to the aging Baby Boom “me generation”, which came of age along with the new post-war consumer society, to be the early adopters of this model.

This “third place” model of healthcare maps directly onto Calderdale and Huddersfield’s Right Care Right Place Right Time (RCRPRT) proposals.

Copying a system used by an American private health care company, Kaiser Permanente,
the RCRTRP proposals aim to cut costly hospital services and replace them with a new, low-cost system of integrated health and social care in the community that’s intended to keep people out of hospital – despite the lack of evidence that this works, or improves patients’ health.

The Right Care Right Place Right Time proposals call this system for keeping people out of hospital “demand management”.

RCRPRT integrated health and social care in the community would require patients with long term health problems to monitor their own symptoms at home using interactive digital technology that will send data about their bodily processes – eg heart rate, oxygen levels in blood, or blood sugar levels – to specialist nurses and/or GPs.

The aim of this is to be able to target care before symptoms become acute, without relying on expensive personal contact between doctors/nurses and patients as a way of checking on patients’ health.

Using so-called risk stratification data, derived from computer models based on patient records, the RCRTRP community care system would direct behaviour change incentives and messages to people statistically at risk of developing various illnesses. This aims to reduce the the likelihood that they will become ill.

Lack of evidence that behaviour change initiatives actually improve people’s health doesn’t seem to be an issue. Big Pharma is sure that they can make money out of them, via data mining patients’ (sorry, consumers’) use of behaviour change apps and social media.

Calderdale and Huddersfield’s “Right Time Right Care Right Place” model is possible because interactive digital technology and social media now allow health care providers (including Big Pharma and digital technology companies) to communicate interactively with patients wherever they are, without needing them to be in hospital, community health centres or GP surgeries.

Big Pharma sees this model as a new source of profits, based on the possibility of creating lifelong relationships between patients and drug companies that would provide unparalleled opportunities for health data mining.

PA Consulting’s role in Calderdale and Huddersfield NHS shake up

A company with a direct interest in this new Big Pharma business model “supported” the development of the Calderdale and Huddersfield Strategic Review. This is a two year piece of work that’s the basis for the Strategic Outline Case aka Right Care Right Place Right Time proposals.

Calderdale and Greater Huddersfield Clinical Commissioning Groups paid the management consultancy company PA Consulting nearly £1m for support with developing the Strategic Review.

PA Consulting advocates the new Big Pharma/life sciences business model in its Future of Healthcare Report, which trumpets the need for “innovation in business models” and “entirely new commercial arrangements”. The Report says,

“The infrastructure, institutions and culture in healthcare can exert powerful forces to maintain the status quo and,
unlike almost any other industry, healthcare professionals – and the institutions in which they serve – hold a special place in the general public’s heart. All this is set to change; all of this has to change.”

PA Consulting has a direct interest in the kind of “patient-centric” integrated health and social care in the community that the Strategic Outline Case promotes. The company is busy working on the kind of centralised digital patient data systems which will underpin RCRPRT care in the community.

In developing these data systems, PA Consulting has been playing fast and loose with patient interests.

PA Consulting’s misuse of pseudonymised patient data, that it had bought from the Health and Social Care Information Service, sparked the  still-unresolved furore over the Government’s care.data plans.

Alarm bells over Data Protection breaches started ringing when the Tory MP for Totnes noticed that PA Consulting had uploaded NHS patients’ pseudonymised data to Google cloud tools, and then produced interactive maps of identifiable patient data.

Turning pseudonymised patient data into identifiable patient data would allow drug companies to target patients directly. It would also allow anyone else who wanted to, to access what should be confidential patient data.

Never let a good crisis go to waste – the rise of rule by unaccountable think tanks and management consultants

PA Consulting’s involvement in the Calderdale and Greater Huddersfield NHS reconfiguration is typical of the way that NHS policy making has been outsourced to think tanks and consultancy companies, at both local and national levels.

New Labour asked the American management consultants McKinsey for advice on how to run the NHS after the banksters crashed the financial system in 2008 and the government spent huge amounts of public money on bailing out the banks. Leaving little to spend on the public.

McKinsey proposed cutting ten per cent of NHS staff, as well as various ways of saving money by making the NHS more efficient. These involved complex reorganisations, including moving care out of hospital into “cost-efficient” settings. The trouble with these proposals was that they required more capital spending to create these new settings.

The key model behind the McKinsey proposal to move care out of hospital into cheaper community services was the Kaiser Beacons pilot, introduced by the New Labour government to trial an American private health care and health insurance company’s system for low cost, integrated health and social care in the community.

Understandably, the NHS workforce went ballistic about the proposed staff cuts and Health ministers said they had rejected McKinsey report.

But in 2009 the NHS Chief Executive Sir David Nicholson took on board McKinsey’s cost cutting agenda and ordered “efficiency savings” of between £15bn-£20bn over the three years between 2011 and 2014. These efficiency savings came from cutting staff – mostly nursing and support jobs – and axing services. Staff numbers at Calderdale and Huddersfield hospitals have fallen over this period, to the point that hospitals staff report they are stressed, overworked and fear for their ability to do their jobs properly.

The Tories came to power on a platform of not reorganising the NHS, and promptly did so. At the same time, pro-privatisation think tanks like the Nuffield Trust were calling for further development of McKinsey’s proposals for increasing “efficiency” by moving care out of hospitals and “integrating” it with social care out of hospital.

In 2010, the Coalition government’s funding plans for the NHS included an annual increase of 0.1% over the next four years – but it also told the NHS to transfer £2.1bn to local authorities over the next five years as part of the drive to cut costly hospital services and move patients into cheaper social or community care, in line with McKinsey’s proposals.

At the Department of Health’s request, the Nuffield Trust and the Kings Fund fed ideas about a national strategy on integrated care directly into the work of the NHS Future Forum. The NHS Future Forum’s June 2011 summary report duly stated,

‘we need to move beyond arguing for integration to making it happen’.

But according to a recent study by MHP Health, the impact of the Coalition Government’s 5 year NHS funding transfer to local authorities has so far been mixed and doesn’t show that transferring NHS funding to local authorities will deliver integrated NHS and social care services.

Lack of evidence was no brake on the Coalition Government’s Health and Social Care Act (HSCA) 2012, which legislated for stealth NHS privatisation completely without any democratic mandate. Central to the HSCA 2012, the Kings Fund national strategy report for “integrated care for patients and populations” said,

“change must be implemented at scale and pace.”

Cuts and changes that trash NHS Constitution pledges to staff

At the end of 2010, in the face of people’s protests at the McKinsey-inspired cuts, Sir David Nicholson told NHS Employers that,

“There are people in the service who hate all this. My view is that they should go.”

It’s not clear how this fits with the NHS Constitution’s commitment:

“• to provide a positive working environment for staff and to promote supportive, open cultures that help staff do their job to the best of their ability (pledge)”

to engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families (pledge)”

Links

Here are links to some documents the article refers to:

Nuffield Trust & King’s Fund Integrated care for patients and populations Report

Progressions 2012 Report The third place: health care everywhere.PDF

PA Consulting Future Of Healthcare Report – pdf

Calderdale and Greater Huddersfield Clinical Commissioning Groups’ £951K contract with PA Consulting