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Private healthcare firms have just been offereda substantial say in deciding how billions of pounds of NHS mental health money is spent.
Health Secretary Matt Hancock outside Downing Street | Jonathan Brady/PA Images
“No privatisation of the NHS on my watch,” said Matt Hancock, Secretary of State for Health, shortly after taking up his post. But this week the Health
Services Journal (HSJ) revealed that “Providers offered control of NHSE budgets worth billions” (paywall).
The article is explicit that the private healthcare sector is central among those now being offered control of at least £2billion of mental health cash.
We’ve got used to privatisation of a lot of NHS services in recent years – everything from ambulances to cataract ops. The latest move – giving private companies responsibility not just for providing NHS services, but decision-making powers over commissioning budgets worth £billions as well – takes privatisation to a whole new level.
‘Commissioning’ means deciding who gets the money to provide NHS services – NHS Trusts, charities or private companies. It means deciding what services those organisations have to provide, who will be allowed to access them and what standards they have to be delivered to.
The HSJ reports that “NHS England has invited providers to take on specialised commissioning powers across the country, in a major expansion of its mental health new care models programme.” There is a “new target for setting up “provider collaboratives” – which are expected to take on the responsibilities and budgets – across the whole of England by 2022, and in 75 per cent of areas by 2020. They will have a lead provider which will coordinate services. It will involve substantial input from private organisations which are major providers of inpatient mental health and learning disabilities beds”.
So it seems important to ask at this point, what kind of role the private sector is already playing in the delivery of mental healthcare for the NHS – and what kind of standards of quality and access has it demonstrated so far?
Often not very good ones, it would seem.
Mental healthcare and private providers
The Care Quality Commission (CQC) issued a report on mental health rehabilitation in March 2018. They found that placements of NHS patients in the private sector were nearly twice as long as similar placements in the NHS. They were more than three times as far away from patients homes and social support – and twice as expensive. And managers at private providers were half as likely as NHS providers to know who was going to be responsible for after-care, post-discharge.
There have been scandals and indeed calls for private providers to lose their NHS contracts after episodes of unacceptably poor care. In one case a 17-year-old girl committed suicide.
The coroner who ruled on the case said her anxiety had been exacerbated by her unacceptably prolonged stay at The Priory one hundred miles from her home in Scunthorpe.
Mental health is not given the priority that it needs regardless of promises from all parties to give it parity of esteem with physical health. All mental health patients, regardless of age, risk being sent long distances from home for in-patient treatment. The majority of locked rehabilitation centres are provided by the private sector.
By giving commissioning responsibilities to private firms there is clear potential for conflict of interest that the money will find its way into private pockets, and that contracts will be designed to suit the private companies who want to bid for them.
Essentially, there are two ways the private sector can win big from the NHS. They can win by getting government contracts and cash to provide services and facilities to NHS patients or other NHS bodies, when directly provided NHS facilities are cut or closed down.
And the private sector can also win by providing services to patients who can pay, if those services simply aren’t made available to NHS patients.
And commissioning decisions – that the private sector has just been offered a huge role in – are absolutely key in both cases.
Public cutbacks, private opportunities
Looking again at specialist rehab centres, we can see how things are already beginning to play out, even before the role of the private sector is further extended into commissioning.
In its recent report the CQC recommended that every Clinical Commissioning Group – the organisations currently responsible for buying the services the NHS needs – should provide specialist rehabilitation facilities. NHS England has responded by saying that it is implausible for them to do so.
But the NHS did used to directly provide rehabilitation services. These were cut from 130 in 2009 to 82 by 2015. The private sector has been the direct beneficiary of these cuts.
In January 2016 The Priory Group was sold for £1.3billion by the US Private Equity Firm Advent International to Acadia Healthcare of Tennessee, a substantial increase from its sale value of £289 million in 2002. Last year, Channel 4’s Dispatches programme included a senior figure at Acadia Healthcare who was explicit about some of the business opportunities offered by the NHS’s cutbacks to its mental healthcare facilities:
“What we would look forward to, or hope does occur, is that the NHS continue to close beds and have a need to outsource those patients to the private providers. We think, that or are optimistic, that if the NHS closes more beds and outsources those, we would be the big winner there.”
The US owned Priory Group is listed in the HSJ story as one of the private sector companies which will be involved in the new budget holding ‘provider collaboratives’. The others include Cygnet Healthcare, a subsidiary of Universal Health Services which is an American Fortune 500 company and one of the largest hospital management companies in the United States and Elysium Healthcare, which is backed by BC Partners, an international investment firm.
The wider context – not just mental health
Understanding the Byzantine changes that are being made to the NHS isn’t made easier by the endless changes of names given to the same processes. But the mental health announcement should be understood alongside a wider move to create Integrated Care Providers (ICPs) across the whole NHS. These are also ‘provider collaboratives’ with responsibility for commissioning as well as service provision. The plans have been of considerable concern to NHS campaigners of late, who have been warning that such moves mean the private sector will become embedded in the structure of the NHS with potentially serious consequences for the care we all receive. There have even been judicial reviews taken by campaigners on the issue, including a very high profile case involving the late Prof Stephen Hawking.
But til now, campaigners’ concerns have been met by rebuffs – and by repeated reassurances that Integrated Care contracts, giving control over billions of pounds of spending, would not be awarded to the private sector.
Move on, nothing to see here
For example, the House of Commons Health and Social Care Committee’s report on integrated care (June 2018) found that the prospect of a private provider holding an ICP contract was “unlikely”. The NHS Long Term Plan also restated the “expectation that ICP Contracts would be held by public statutory providers”. Andrew Selous MP, member of the Health and Social Care Committee speaking in the NHS privatisation debate quoted Professor Chris Ham of the King’s Fund. “If you look at what is happening in the partnerships—places such as Salford, Northumbria, Wolverhampton, Yeovil and South Somerset—there is absolutely no evidence of privatisation”. And fellow Committee member Ben Bradshaw MP told his colleagues, “The other advocates of these integrated models are not just people such as Chris Ham but people we have spoken to on the ground, trying to deliver a service for their local population….. it makes it less likely that they are going to be private contracting.”
Such reassurances have been going on for some time, of course – with David Cameron insisting in a BBC interview that there would be “no privatisation of the NHS”, and Theresa May answering concerns about US private health firms involvement by telling parliament “The NHS is not for sale”.
And they continue at the highest level. Earlier this year there was a decidedly awkward moment in front of the House of Commons Health & Social Care Select Committee after Simon Stevens, the NHS England CEO, tried to deflect repeated questioning over this key issue of ‘non-NHS bodies’ running NHS budgets.
Choosing his words carefully, Stevens said “we are suggesting that the integrated care should be from public providers”. Then – impatiently – Secretary of State Matt Hancock stepped in with his bravura statement. He said: “I am going to be much more concrete. There is no privatisation of the NHS on my watch, and the integrated care contracts will go to public sector bodies to deliver the NHS in public hands.”
In the face of such insistence, even some campaigners found it difficult to understand why the private sector would be interested, especially as there have been some spectacular failures of private sector contracts. Indeed, one of the pilots for a mental health ‘provider collaborative’ for Kent, Surrey and Sussex was quietly withdrawn without explanation at the end of last year. It contained more private sector providers than any of the other planned groupings.
But they are interested – and they are being awarded a part in the contracts, because they are already an integral part of the provider network. And NHS England has made clear that it will continue on its path regardless of evidence that it’s not in the interests of patients.
‘Backroom’ services
Already these private sector companies are providing some ‘backroom’ services. The word ‘backroom’ conjures up images of clerical work of little importance but it turns out to mean, amongst other things, advising and drawing up specifications on tendering processes for contracts worth £millions. Another key player in ‘backroom’ services is Optum, subsidiary of US health giant UnitedHealth (the organisation that formerly employed NHS boss Simon Stevens himself). Optum already provide a variety of back office services to the NHS, and according to US magazine Healthdive, the company has been on an acquisition spree to position itself as a leader in Integrated Services. It is working closely with organisations like Modality, the GP Super Partnership based in the West Midlands, who’ve just been awarded ‘custodianship’ of funds for bank and ‘back office’ services for Primary Care Networks, one of the new models for GP provision.
All of this should be a hot topic in England, knocking even the loss of GPs off the top news slot and sending shockwaves through the NHS. The private sector, including US-owned companies, looks like it’s about to be embedded in greater positions of power.
How much of the NHS must be controlled or heavily influenced by private interests before backbench MPs from all sides of parliament wake up and realise they have an awful lot of explaining to do to their constituents? Or, like ‘backroom’ and ‘outsourcing’ will ‘provider collaboratives’ just become more words for ‘move on, nothing to see here?
With many thanks to: Open Democracy and Jessica Orderod and Deborah Harrington for the original story
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Theresa May said last month that the extra £20bn a year pledged to fund the health service would be partially paid for by UK money no longer being sent to the European Union.
That claim was universally slammed by economists as grossly misleading, since the Government’s own projections suggest Brexit is already weakening the public finances, rather than strengthening them and that any fiscal gains from zero EU payments will be wiped out by feebler tax revenues.
The Government has also already earmarked much of those net £13.3bn a year EU budget payments for other major spending items such as support for farmers and science.
Why May’s £20bn isn’t really a 70th birthday present for the NHS
And on Tuesday the Office for Budget Responsibility, established in 2010 to provide authoritative and independent fiscal forecasts for the Government, confirmed that no Brexit boost for the public finances is expected.
“Our provisional analysis suggests Brexit is more likely to weaken than strengthen the public finances overall,” the OBR said in its latest Fiscal Sustainability Report.
“There will be direct savings from the net contributions to the EU budget that the UK will no longer have to make, but it is unclear how much will be available after payments towards the agreed withdrawal settlement and other Brexit-related spending commitments.”
Instead, the OBR said that the unfunded £20bn extra a year health pledge (within five years) had worsened its long-term state projections for the public finances relative to its equivalent forecasts last year.
“Our projections suggest that the public finances are likely to come under significant pressure over the longer term, due to an ageing population and further upward pressure on health spending from factors such as technological advances and the rising prevalence of chronic health conditions,” it said.
Health economics specialists have warned that that the extra funds pledged by ministers may still not to be enough to match rising demand pressures over the coming years.
That too was given support up by the OBR on Tuesday, which estimated a £2.8bn funding gap in 2022-23.
On the overall finances over the long term, assuming no tax rises or spending cuts, the OBR said that the primary budget deficit (which excludes interest payments) was set to creep up from 0.3 per cent of GDP in 2022-23 to 8.6 per cent of in 2067-68.
NHS at 70: demonstration and celebration march to mark anniversary
This would mean public sector net debt as a share of GDP rising from 80 per cent in 2022-23 to 282.8 per cent of GDP over fifty years.
“Needless to say, in practice policy would need to change long before this date to prevent this outcome,” it said.
“Broadly speaking, the fiscal position is unsustainable if the public sector is on course to absorb an ever-growing share of national income simply to pay the interest on its accumulated debt.”
In response to the OBR’s document, the Treasury published its own analysis entitled “Managing Fiscal Risks”.
“Boosting productivity is the key to a stronger economy, a more sustainable fiscal position and, crucially, a better quality of life for everyone,” wrote the Chancellor, Philip Hammond.
“That is why we are building a globally competitive economy through our modern Industrial Strategy, increasing public investment to its highest sustained level in over 40 years through the £31 billion National Productivity Investment Fund, and equipping our workforce for the high-skilled, high-wage jobs of the future.”
He also cited specific steps such as reforming the tax system and raising the pension age. The document does not, however, mention specific tax rises to pay for the promised NHS funding increase.
With many thanks to: The Independent for the original story.
This website is completely a freelance website all of the news on this site is brought to you personally by me with no donations. I would like to request for personal donations to help me keep it up and running. please consider donating £5 https://www.paypal.me/KevinMeehan
This website is completely a freelance website all of the news on this site is brought to you personally by me with no donations. I would like to request for personal donations to help me keep it up and running. please consider donating £5 https://www.paypal.me/KevinMeehan
‘It is a matter that the NI executive needs to address in terms of accountability – Kieran Bannon.
THREE hundred so-called gagging orders have been used to silence public-sector workers – the majority former police officers – since 2009. The orders can be used to prevent staff speaking publicly to the press about their former employer.
Also known as confidentialityclauses, they are usally agreed when an employee is made redundent or leaves an employer following a workplace issue or disagreement. More than 230 police officers and 50 staff members at the Stormont executive agreed to confidentiality clauses. The clauses can be used in settlement agreements to stop industrial tribunal cases being heard and can cost the taxpayer tens of thousands of pounds. In March the British government banned gagging orders for NHS employees after it emerged that more than £18 million had been spent on silencing 600 staff. The issue has caused uproar at Westminster, with communities secretary Eric Pickles warning against using “under-the-counter pay-offs to silence departing staff”.
Civil service union Nipsa expressed concerns over public funds being used “simply to silence individuals”. Kieran Bannon, assistant general secretary of Nipsa, said that confidentiality clauses can “undermine the principles of accountability and propriety”. “It is a matter that the NI executive needs to address in terms of accountability, firstly in relation to the use of public funds but equally the accountability of public-sector employers for their actions,” he said. A total of 236 PSNI officers agreed to confidentiality clauses as part of employment tribunal settlements. Almost 200 of these were part of a class action settled earlier this year, according to a freedom of information request submitted by The Irish News. The Department for Social Development (DSD) accounted for the vast majority of the confidentiality clauses used in the executive, with 39 imposed since 2009.
Five staff members in the Department of Agriclture and Rural Development agreed to confidentiality clauses as part of compromise agreements. The Department of Health also used confidentiality clauses in two out-of-court settlements relating to industrial tribunal cases. Other public bodies also revealed some employees agreed to gagging orders over the past four years. Eight assembly staff members agreed to confidentiality clauses. None of the cases prevented employees from whistleblowing. A total of 16 Western Health and Social Care Trust employees and one ambulance service staff member agreed to confidentiality clauses since 2009. One Belfast trust employee agreed to a confidentiality clause as part of the termination arrangement. The trust said the clause was mutually agreed and phrased to “protect both the employer and employee”, with no specific clauses in relation to the press. According to employment lewyers, most compromise agreements include confidentiality clauses. They can be used to bar employees from talking publicly or to the press about their former employer of the circumstances under which they left. Mr Bannon said confidentiality clauses usually form part of compromise agreements and are used in tribunal settlements to stop cases being heard. “Nipsa would have concern if public funds were used simply to silence individuals,” he said. “The use of confidentiality clauses means the general workforce and the public are not aware of the actions of the employer and in a case involving public-sector staff it is even more important that the employer is held to account for its actions given the potential impact on public funds.” No figures were available to determine how much was spent in the north’s staff settlements that used confidentiality clauses. A DSD spokesman said : “We are not in a position to make an informed comment how this department’s figures compare to others. DSD is, however, the largest of the Northern Ireland Civil Service departments.”
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GPs are taking charge of the majority of the NHS budget under the reforms
The number of GPs who believe that the government’s health reforms in England will improve patient care is falling, a BBC poll suggests.
Just 12% agreed that putting GP-led groups in charge of the budget would mean patients saw a “noticeable” improvement.
That figure was 23% when a similar poll was carried out in September 2010.
A majority of the 814 GPs polled also believed there would be more rationing of care because of financial pressures.
In total, 83% said there would be an increase in rationing in their area.
Ministers have cited the financial challenges facing the health service as one of the reasons they have pushed ahead with the changes in the face of mounting opposition.
While 12% of family doctors agreed that GP-led commissioning – the buying and planning of services on a local level – would improve care, some 55% said they disagreed and 33% said they did not know whether or not it would.
The polling also asked about another controversial aspect of the reforms – the role of the private sector.
Asked about the role of private companies in the NHS, 87% agreed the changes set out in the health bill would lead to them having a bigger role.
The King’s Fund, a health think tank, said the poll highlighted once again the challenge facing the government in carrying the NHS with it as it implemented the health reforms.
“GPs will be in the vanguard of this – their commitment is essential for implementing clinical commissioning, the government’s big idea for ensuring that care meets the needs of patients,” said chief executive Chris Ham.
“The public will judge the government’s stewardship of the NHS on the basis of whether patient care improves, so ministers should be concerned that many GPs fear that care will get worse rather than better in the years ahead.”
Dr Laurence Buckman, chairman of the British Medical Association‘s GPs committee, said the findings came as no surprise and reflected what doctors had been telling them directly.
“Increasingly, GPs are worrying that they will be blamed for making the hard decisions that may need to be made in order to meet the £20bn savings target set by the government. The government needs to be much more upfront with the public about the scale of savings that need to be made and why.
“If those who will have to deliver the latest health reforms are unconvinced and reluctant, the government should take notice of what they say.”
April changes
In April next year the control of about £60bn of the NHS budget in England is due to pass to GP-led groups that will plan and buy most routine healthcare for their local community.
More than anyone else in the NHS, GPs are central to the government’s plans for the NHS.
If you’re a patient in England, your surgery will have agreed to work with others in your area. From April 2013, these GP-led groups – 240 of them – will be taking control of £60bn of the NHS budget.
So what GPs think matters, because they’re essential to making this new system work.
This polling by ComRes suggests a deepening scepticism among GPs that putting them in charge will improve patient care.
Some believe they have been given too little power. Others are worried they’re taking over as the NHS faces the lowest growth in its budget since the 1950s.
They will be taking over at a time of unprecedented financial pressure. The latest government statistics suggest the NHS is currently managing to meet all waiting targets and has found the savings needed in the last financial year. The polling for the BBC suggests considerable anxiety about what lies ahead.
Almost half of the GPs, 49%, thought the NHS would not be able to go on meeting the 18-week target for routine treatments. Just 22% thought that it would be possible. A similar picture emerged for A&E departments, with 42% agreeing the NHS would need to close or downgrade some in the next five years.
The health secretary Andrew Lansley said the Health and Social Care Act would hand power to GPs, put patients at the heart of the NHS, and reduce needless bureaucracy.
“Of course, every important reform to the NHS, under whatever government, has had its critics from within the system. But putting GPs in leadership positions in the NHS will mean they can improve services for their entire local population. Patients want doctors to make decisions about their care, not managers, and that is what our reforms will deliver.”
Andy Burnham, Labour’s shadow health secretary, said the findings were significant.
“Most GPs are clear that the NHS is going in the wrong direction and that the government’s changes will make it worse not better. These results echo the concerns Labour has consistently raised and flatly contradict the reassurances given by the prime minister to get his Bill through.”
The poll interviews were carried out by ComRes for the BBC between 21 and 30 March.
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