The not-so-hidden agenda of the government and its NHS privatisation quango (the NHS Commissioning Board, aka NHS England) is to de-fund, run down and privatise the NHS by the end of this Parliament.

Here is how this is playing out in Calderdale.

De-fund

Cutting £20m/year from Calderdale’s NHS budget until 2019

The Care Closer to Home scheme, which NHS England is imposing in Calderdale and across the country, is dressed up as an improvement to NHS and social care services, but it’s really about making £22bn worth of NHS cuts by 2020.

According to Calderdale Clinical Commissioning Group, Calderdale’s share of these cuts amounts to £80m in the four years between 2014/15 and 2018/19, and its Care Closer to Home scheme is key to making these cuts. (Source: Calderdale Care Closer to Home Service Specification, 20 Jan 2015 Version, Draft 13.1, p19)

Care Closer to Home is directed at the frail elderly and adults and children with chronic and complex illnesses and care needs. These types of patients are the biggest attenders at A&E and have the most acute hospital admissions.

The plan is to attempt to reduce their A&E visits and acute hospital admissions, by transferring costly hospital services into local health centres and people’s homes, where their health problems can be treated and kept in check more cheaply, without having to go to A&E.

This is supposed to make it ok to cut and close costly acute and emergency hospital services, on the assumption that there will be less demand for them. However there is no real evidence that this assumption is correct.

This transfer of care into the community, combined with cuts to acute and emergency hospital services, is central to the increasingly obvious government programme to defund, run down and privatise the NHS.

Run down

Through a Freedom Of Information request, I found that Calderdale and Greater Huddersfield Clinical Commissioning Groups think that their big “challenge” in setting up Care Closer to Home is:

“Realigning the mindsets of individuals, their carers and their health professionals to this vision.”

It all sounds a bit like North Korea to me.

Why should the patients, carers and health workers who are going to be affected by Care Closer to Home need their “mindsets” “realigning” to its “vision”?

Particularly since the CCGs are at pains to say that Care Closer to Home is giving patients what they’ve told the CCGs they want.

I asked Greater Huddersfield Clinical Commissioning Group this question at their AGM in July.

Dr Judith Parker, the GP Practice Rep, told me:

“Realigning patients’ and their carers’ mindsets is about resilience and self management – a different way of health services – enabling and empowering people to take care of themselves and control of their health needs.”

But “resilience” and “enabling and empowering people” are code words for cutting public services, making patients and carers take the burden of care, and radically downgrading clinicians’ working practices, terms and conditions.

As for NHS staff, there are many reasons why the CCGs want to “realign their mindsets to the this vision.” For a start, the Care Closer to Home Evidence Pack for the 13 August 2105 Calderdale CCG Governing Body meeting states (p21) that staff at Locala (the company that provides Kirklees community health services) want to come back into the hospital setting as they feel isolated – despite their interactive digital technology.

And then there’s the issue of NHS England’s imposition of “New Care Models” that require staff to offer managed care that follows set protocols and pathways – thus deskilling doctors and turning them into box tickers. Plus the privatisation quango’s plan for a “modern workforce” that discards NHS national terms and conditions. (see Modern Workforce section, below)

Contraction and denial of care will get worse

Since the Health and Social Care Act 2012, the NHS as a comprehensive, universal health service no longer exists.

The duty of the Secretary of State to provide it has been abolished. Nor do Clinical Commissioning Groups have a duty to provide a full NHS service in their area. The only service they have to provide is urgent and emergency care.  Across the country, many CCGs are now refusing/withholding a variety of treatments and care.

Retired surgeon and BMA members Anna Athow told Support the NHS campaigners at a recent workshop in Dewsbury that NHS England’s 5 year plan will engineer:

“a massive contraction and denial of care”.

This is already underway in Calderdale and Kirklees. There are three main ways of restricting and denying care:

• a decision by CCGs to restrict access to services
• the imposition of long waiting lists
• the invitation to jump the queue by paying for private treatment.

All three are happening in Calderdale and Kirklees.

Along with 2/5 of the CCGs in England, NK Kirklees CCG has plans to restrict patients’ access to a variety of services, in order to save money. A public event in Batley on 8th July heard the CCG say that a range of drugs and special diets are for the chop.

Some patients in Calderdale face unacceptably long waits for treatments.

Children aged 0-5 with additional needs for more support to learn basic skills are having to wait six months for an initial assessment by Calderdale Council’s Early Years and Portage Support Team. Following the assessment, a parent was told their child was at the top of the waiting list and might be assigned an early years tutor or portage worker in another six months.

An infant’s complex communications assessment, related to diagnosing and supporting children with autism, also involves a year’s wait from referral.

Some community mental health therapists have had their clinic time cut so that they can cover for crisis teams’ work. As a result, service users’ access to their therapist has been reduced, and the waiting list for the service is now two years and getting longer.

The parent of an infant who was referred for speech and language therapy in the autumn of 2014 waited three months for a first appointment, when they were told that they would have to wait another five months for a S &L therapist to be assigned to their toddler. But if they were prepared to pay £20/hour for private therapy sessions, Speech and Language Therapy could be accessed much sooner.

The pattern is clear, to drive patients with good enough health and enough money to pay for private health insurance out of the NHS.

Privatise

Vanguard – spearheading “New Care Models” that will dismantle the NHS

Care Closer to Home is being fast tracked in Calderdale through NHS England’s “Vanguard” scheme.

Scores of Vanguards across the country are setting up the first wave of “New Care Models” that copy private American health insurance companies’ systems.

This process, if allowed to go ahead, will finish the 2012 Health and Social Care Act’s task of stealth-privatising the NHS.

Private American health care is hugely expensive and relatively ineffective, run by profiteering and sometimes corrupt health companies, paid for through private health insurance and is the main cause of household bankruptcies: health insurers won’t cover chronically sick people who they can’t make money out of, or poor people who can’t pay the premiums.

If you want to get a sense of how a privatised health care system works, think of how NHS dentists have been privatised. How much dental care can you get on the NHS these days?

Typical of findings across the country, a 2014 Kirklees Healthwatch Report on access to NHS dentistry reported:

“The shift in many dentists from the NHS to the private sector has made it difficult for people to find an NHS dentist when they need one… NHS Choices website states that in Kirklees there are no dental practices currently accepting NHS patients…Significant number of patients in Kirklees are struggling to find an NHS dentist for routine NHS treatment… if you are elderly, homeless or experience social exclusion in some way then your position is even worse.”

Although America’s privatised health care system is pretty crap for patients, it’s a source of massive profits for the companies that run it. And now they have their eyes on the rich pickings of the publicly-funded NHS.

Simon Stevens, now head of NHS England, was previously employed by the global American health insurance company United Health. United Health’s fingerprints are all over the “new care models” that are central to the quango’s Five Year Plan.

An NHS “modern workforce” that is locally flexible, without national terms and conditions

The “New Care Model” to be set up through the Calderdale Vanguard is the Multi-speciality Community Provider (MCP).

As promoted by global American health insurance company United Health, an MCP “care model” is designed for areas that are unattractive for GPs to work in; it compensates for this by replacing GPs with Physician Assistants, Nurse Practitioners and other less qualified staff.

Debbie Graham, Calderdale Clinical Commissioning Group’s Head of Service Improvement, told Plain Speaker,

“Being a GP is not an attractive occupation, so we have to think about alternative models. We have to think about workforce changes and what roles they might create. What sort of workforce will we have in the future and what new jobs will there be?”

Iain Baines, Head of Adults Health and Social Care Safeguarding and Quality at Calderdale Council, added,

“Vanguard isn’t going to solve Adult Health and Social Care and NHS staffing problems. There’s a decrease in GP and other health professionals’ training. So can other staff do their jobs?”

Calderdale MCP Vanguard’s plans for workforce changes are in line with NHS England’s 5 Year plan for a “modern workforce” which introduces local “flexibility” and ends national NHS terms and conditions.

The General Practice Committee deputy chair Dr Richard Vautrey doesn’t agree with the MCP system. He told Pulse Online:

“The bottom line is that there is only three-quarters of the historical investment left in general practice and working at scale won’t help solve this problem. We need to get back to 11% of NHS funding spent on general practice to have any chance of addressing the current crisis.”

Physician Assistants are among the new, less-qualified workers that MCPs will be staffed with. These are new roles in the UK, imported from America in 2005. Leeds University has just set up a two year course to train Physician Assistants – but the person responsible for the course has tweeted that it remains to be seen how useful they are.

There is no UK regulatory body to provide a code of conduct and standards that Physician Assistants/Associates can be held accountable to – as there is for all other healthcare workers. Physician Assistants/Associates only have a Managed Voluntary Register and some PAs are not even on it: in some Trusts, this is optional not mandatory.

Physician Assistants (Anaesthesia) and Physician Associates are themselves now petitioning the government for statutory regulation of their role , since they are not happy with their unregulated situation.

The government is using third sector and voluntary organisations to carry out backdoor NHS privatisation

The Calderdale Multispecialty Community Provider will also rely heavily on third sector and voluntary organisations to provide a range of health and social care. Calderdale CCG’s contracts register shows it has granted £750K to Voluntary Action Calderdale, to train voluntary organisations and social enterprises in how to bid for health and social care contracts and also to champion Care Closer to Home to voluntary and community groups, for which they are paid as “engagement champions” or “community assets”. Voluntary Action Calderdale has also channelled £2m of NHS money from Calderdale CCG into local voluntary organisations

As Sussex Defend the NHS has reported, leaked minutes of a 2010 meeting between Tory Cabinet Officer Minister Francis Maude MP and the Confederation of British Industry show that the government has been using third sector and voluntary organisations to carry out backdoor NHS privatisation. All kinds of problems, including declining quality of care, worsening terms and conditions of employment and inadequate resources, have followed from voluntary/third sector takeover of NHS services.

But Simon Stevens, Head of the NHS privatising quango, sees the voluntary and community sector as key to:

“get[ting] serious about demand moderation and the rate of growth of services”.

Two years until Calderdale NHS is run by an American-style Accountable Care Organisation

I put it to Debbie Graham, Head of Service Improvement at Calderdale Clinical Commissioning Group, that the endgame of NHS England’s five year plan is the privatisation of the NHS along American lines. She said:

“We’re a long way off that.”

But in two years, the Calderdale Vanguard aims to have set itself up as an Accountable Care Organisation. Also known as a Health Maintenance Organisation, this is an American form of health company that provides managed care ( ie care that follows set protocols and pathways) for a private health insurance company.

Health Maintenance Organisations (HMOs) were promoted by President Nixon through the HMO Act of 1973, before he resigned in 1974 to escape impeachment for obstruction of justice, abuse of power, and contempt of Congress.  John Ehrlichman – later imprisoned for his role in the Watergate scandal – persuaded Nixon that HMOs were the future for American healthcare on the grounds that:

“All the incentives are toward less medical care, because the less care they give them, the more money they make.”

We are back with Dr Judith Parker’s statement about realigning patients’ and carers’ mindsets towards:

“…a different way of health services – enabling and empowering people to take care of themselves and control of their health needs.”

Calder Valley Multi-speciality Community Provider Vanguard – a private company that monopolises Calderdale NHS and social care

The Calder Valley MCP Vanguard (soon to be an Accountable Care Organisation) will be based in the large, under-used Todmorden Health Centre that is owned by the medical property development company Assura.

An MCP is a large scale, GP-led company – designed to serve a population of around 300K – that is a “lead provider” of:

• primary care (GP services, dental care, pharmacy, eye care)
• community health services
• specialised hospital care
• some urgent care

Being a lead provider means it provides most services itself and subcontracts out the rest.

The endgame of this new care model is that the MCP also ends up running the (downgraded) local hospital, which has had many of its services hived off to large specialist regional centres.

In Calderdale, the GP company that is intended to become the Vanguard MCP is Wainhouse Healthcare Ltd, a private shareholder limited company also known as Pennine GP Alliance

The GP member practices of Wainhouse Healthcare Ltd are the same as the GP member practices of the Calderdale Clinical Commissioning Group governing body. This presents the interesting prospect that the commissioner and lead provider for almost all Calderdale’s health services – bar some specialist acute hospital care and A&E – will be one and the same.

So this private company will have a monopoly position.

No wonder Andy Burnham (who has promised that under a Labour government there would be a “significant role” for private companies in the NHS) wants to repeal the competition section of the Health and Social Care Act 2012.

And could it be that one reason Cameron wants the UK out of the EU is so that its competition laws – having been used to open up the NHS to private health care companies – don’t hamper private companies’ monopoly takeover of the NHS.

The mental health trust is alive to the fact that EU competition law poses problems for the rollout of NHS England’s 5 Year Plan for new care models. Its Strategic Plan 2014-2019 states that the only way it can survive financially is:

“…to be part of a bigger entity with critical mass as a specialist mental health and community provider “

But it identifies as a Strategic Risk:

“Commissioners and regulator concerns – potentially re competition impact.”

Are you happy for this to go ahead?

Calderdale Clinical Commissioning Group’s Care Closer to Home Evidence Pack says there have been no complaints about their proposals over the last three years.