As a group working for a fair, healthy, sustainable food system that can help solve the epidemic of obesity and diabetes caused by the current dysfunctional food system, Growing Futures recently took part in the Voluntary Action Calderdale workshop on Understanding how the NHS works in Calderdale.
The main information at the Workshop was that the NHS in Calderdale now operates just like any marketplace.
The VAC training workshop was part of its 3 year, £750K contract with Calderdale Clinical Commissioning Group, for Third Sector Development and Support.
This contract, dating from March 2013, includes informing VCSE organisations how to bid for health and social care contracts in the upcoming wave of NHS cuts and privatisation in Calderdale, that goes under the name of Right Care Right Place Right Time, aka Care Closer to Home.
These proposals have still not gone to public consultation , nearly two years after they were announced to massive public protest.
With the so-called Lansley reforms, aka the Health and Social Care Act 2012, our NHS has been turned from a publicly-owned, publicly-run comprehensive, universal service that was accountable to the Secretary of State for Health, to a market-based system.
A marketplace where a key buyer and seller were for months locked in dispute over a massive contract, for the provision of Calderdale Royal Hospital services for the financial year 2015-16.
No information was forthcoming at the Workshop about whether the dispute has now been resolved and the contract signed.
A video shown at the Workshop spun the removal of the duty of the Secretary of State for Health to provide NHS services, as a reform that has reduced
“politicians’ power to interfere with the NHS”.
It was clear at the Workshop that the the NHS is being inexorably driven down the road to an American private health insurance system.
On reflection, Growing Futures are uneasy that NHS money from Calderdale Clinical Commissioning Group funded Growing Futures’ attendance at the VAC workshop, because NHS money should be spent on patient care. It should not go on explaining to Voluntary, Community and Social Enterprise (VCSE) organisations how the NHS works, so that they can bid for NHS contracts
Growing Futures is refunding our share of the cost of the VAC Workshop to Calderdale Clinical Commissioning Group, so the money can go on patient care.
Summary of points raised at the VAC Workshop
The VAC workshop was carried out under Chatham House rules, which means that everyone present agreed that outside the workshop, no one would report who said what in the workshop. Only what was said can be reported outside the Workshop, not who said it.
Three VCSE organisations, including Growing Futures, took part in the workshop, together with three members of the public with concerns about the way that the NHS is being inexorably driven down the road to an American private health insurance system.
At the Workshop, the following points were raised. Some of them are mutually contradictory. This reflects the range of views in the room. It is not an exhaustive list, but aims to include enough points to give a fair sense of different viewpoints exchanged by those present.
The NHS operates just like any marketplace
The NHS has been turned from a publicly-owned, publicly-run service that was accountable to the Secretary of State for Health, to a market-based system.
This is despite the fact that 88% of the UK public wants a publicly-owned, publicly-run NHS, as shown in a YouGov poll.
The NHS now operates just like any marketplace – providers offer services to buyers.
The marketised NHS system is based on a commissioner/provider split, where commissioning organisations decide what services will be available in their area, and buy them from providers, through contracts.
In Calderdale the NHS commissioners are Calderdale CCG, Calderdale Council and NHS England.
Since the 2012 Health and Social Care Act, local authorities have taken quite a big chunk of NHS money, although people don’t think of the Council as an NHS organisation.
If a commissioner wants to buy something that a provider doesn’t offer, they’ll go elsewhere or ask the provider to ‘stock’ it.
The commissioner buys services from providers on the basis of a contract between them. Some contract terms are set nationally, some locally.
The government tells CCGs what they must spend money on for four national targets.
Some decisions about what to spend money on are based on the Joint Strategic Needs Assessment. (JSNA). This is an assessment tool that assesses health needs in the area. Some decisions are based on feedback from local people.
Calderdale CCG and the Yorkshire and Humber Commissioning Support Unit try to develop contract specifications on the basis of local information.
Calderdale & Huddersfield NHS Foundation Trust/Calderdale Clinical Commissioning Group contract dispute
In August 2015, the Calderdale Clinical Commissioning Group Governing Body said that the CCG had still not signed the 2015/16 contract with the hospital’s trust (CHFT), for hospital and community health services for the people of Calderdale.
This was because of a dispute over the contract between the CCG and the Foundation Trust. A dispute resolution organisation had been brought in to resolve the dispute.
No one in the room knew or would say if that dispute had now been resolved and the contract signed. Anyone who wants to know can ask Calderdale CCG.
Kings Fund video spin about the 2012 Health and Social Care Act
The Kings Fund video explaining the NHS system set up by the Health and Social Care Act (HSCA) 2012, (aka the Lansley reforms), is tendentious. It omits key information about the effects of the HSCA 2012. Specifically:
- It does not say that since the 2012 HSCA, NHS commissioners must put out to competitive tender all contracts valued above a fairly low threshold. Any qualified provider can bid. This includes private companies and has has accelerated the privatisation of the NHS that has been ongoing over the last 25 years.
- It fails to mention that the 2012 HSCA removed the duty of the Secretary of State for Health to provide a comprehensive universal health service that is free at the point of need and based on patients’ clinical needs. Instead it spins that the HSCA 2012 reduces “politicians’ power to interfere with the NHS”.
The removal of the Secretary of State’s duty to provide the NHS effectively dismantles the NHS.
First, the bureaucrats who run the NHS are no longer accountable to the public through Parliament.
Second, it destroys the core principle of the NHS: that wherever and whoever they are, people can, as of their right, have access to all available NHS treatments and services based on their clinical needs.
The HSCA 2012 was completely undemocratic. No political party had included anything about it in their 2010 election manifestos.
The Tories didn’t end up with the HSCA 2012 they wanted, because they had the LibDems in the Coalition government with them. The LibDems gave increased responsibility for public health to Local Authorities and Public Health England, and set up Health and Wellbeing Boards.
At the South and West Yorkshire mental health Trust’s 2014 AGM, a member of the audience asked if the HSCA 2012 was really stealth-privatising the NHS. The mental health Trust’s Chair stated that the new commissioning processes, that require commissioners to invite competitive bids from any qualified provider for all contracts above a certain amount, is damaging NHS providers by handing over contracts that they previously held, to private companies.
Prioritising VCSE above the public sector
VAC is prioritising Voluntary, Community & Social Enterprises (VCSE) above the public sector.
This raises the question of whether it’s ethical for VCSEs to bid for contracts, when this risks undermining the NHS by potentially taking work away from NHS providers.
VSCEs can run high quality social care services providing meaningful activities at bargain prices for people with low level needs (£5.80/person/hour) For people with high level needs who need one to one care, the cost is higher at £14/hour.
Service users of some VCSE health and social care services have to pay to use the services. Some pay using Personal Health Budgets (PHBs). (PHBs are NHS money for continuing care patients that is handed over to the patients to buy in continuing care, rather than using NHS continuing care services).
Other service users are funded by Calderdale Council, through referrals from social services through Gateway to Care. VCSEs are worried about this because of the pressure on Calderdale Council’s finances as a result of central government cuts to their funding.
VCSEs are worried about cuts and privatisation. They worry about what will happen when services are gone and what the service users will do.
VAC will be running a workshop on the Care Act.
The NHS commissioning system set up by the HSCA 2012 is incredibly complicated. It is hard to understand. VCSEs are saying they don’t have enough information.
NHS Foundation Trusts
CHFT, (the Calderdale and Huddersfield NHS FoundationTrust), provides NHS hospital and community services. In the NHS “marketplace”, they sell their services to the Clinical Commissioning Groups.
As an NHS Foundation Trust, it is an Independent Public Benefit Corporation that is able to hold its Board meetings in secret, keep its all its Board papers secret and so cannot be held accountable to the public.
Under the HSCA 2012, it can earn up to 49% of its income from private patients and commercial income.
This potentially limits the services it offers to the NHS.
NHS Reinstatement Bill
The NHS Reinstatement Bill, a cross-party Private Members Bill that is due for its second reading in the House of Commons on 11 March 2016, would restore the NHS as a publicly-owned publicly run service that it is the duty of the Secretary of State to provide, and that is comprehensive, universal, free at the point of need and based on patients’ clinical needs.
It would solve the current NHS funding shortfall and the social care crisis by returning at least £4.5bn/year to patient care, since the wasteful, costly market bureaucracy which costs at least this amount would be abolished. (The cost of providing free critical social care is estimated by the 2014 Barker Report at less than £3bn and the annual NHS funding shortfall is around £2bn).
It was agreed that VAC will circulate this Bill to workshop participants, along with other papers from the Workshop
Better Care Fund
The Better Care Fund (BCF) is a joint pot of NHS and local authority money. The Clinical Commissioning Group (CCG) puts in £13.8m/year and Calderdale Council puts in £1.6m/year. Because they put in most of the dosh, the CCG is the lead commissioner for health and social care services commissioned through the BCF.
The BCF is about sharing resources and schemes between the NHS and social care, in 7 areas:
- supported self managed care and prevention
- promoting independence
- holistic care assessments and case management
- reablement,recovery and rehabilitation
- hospital admission avoidance and supported discharge
- support at end of life and IT enablement (medical records, personal confidential medical data)
NHS England’s Five Year Forward View
The information provided about NHS England’s Five Year Forward View plan to turn the NHS into a social movement is full of spin that hides a worrying agenda.
The idea of patient choice is about treating people as consumers not citizens.
When they need health care, people are consumers.
The aim of increasing patient choice is beside the point, because healthcare isn’t a supermarket. When they’re ill people don’t want to go shopping for treatment, they want to know there’s a good quality local NHS that will take care of them.
Patient choice makes it harder for GPs because they don’t necessarily have a relationship with the provider or providers their patient ends up choosing.
NHS England’s aim of helping people to stay in employment says nothing about how it’s going to do it. Does this mean that GPs will give out fewer sick notes so people who should be off work recovering or coping with their poor health are forced to go on working?
Commissioners’ “engagement” with the public
Yorkshire and Humber Commissioning Support Unit is trying to work more with VCSE to engage with the public and patients through engagement champions in VCSE organisations.
This is because the CCG wants help engaging the public and VCSE organisations to find out what health and social services they want and how they want them provided.
Getting people to understand the system and the options is really hard.
If the HSCA 2012 hadn’t removed democratic accountability from the NHS, all this engagement wouldn’t be needed because decisions about what health and social services we want would be decided democratically, in Parliament, with MPs accountable to their constituents.
There is a level of cynicism about engagement. What people want is often at odds with finances and affordability.
All participants in the workshop agreed that the NHS commissioners are driving the NHS inexorably down the road to an American private health insurance system.
How much do the CCG and the CSU really understand about how people feel about the dismantling of socialised health provision – ie a quality comprehensive health service that is free at the point of delivery, not an American-style private health insurance company system where there are only basic public health services?
People are worried about NHS cuts and want to know where the services are coming from and what happens to patients when services are no longer available
People feel that the CCG are tricking us – they are taking us down a road to private health insurance, without telling us where we’re actually heading.
There is no certainty that people in the CCGs and other NHS organisations know where they’re actually heading.
Some people think it’s an open secret, that the people in the CCG etc know what they’re doing.
The CCG and CSU does not talk among itself about these issues.
The CCG and CSU should be talking among itself about these issues , to discuss how they could take the market out of the NHS at their local levels in line with the proposals in the NHS Reinstatement Bill.