The NHS.. it's what you don't see coming!
Article written by PAULA PETERS. 6th January, 2013
Published online at: http://socialwelfareunion.org/archives/2954
For the longest time, I have been worried and very concerned about what is happening to the NHS in England. The introduction of the Private Finance Initiative, of which my trust in South London is currently under special administration and faces being broken into pieces under proposals that are with the current Health Secretary Jeremy Hunt as we speak.
In April 2012, the Health and Social Act came into being. Under this act, the primary care trusts as you know them to be now, will be abolished and replaced on 1st April 2013 by Clinical Commissioning Groups, (CCG’s).
The CCG’s, are the groups of GP’s, and “other healthcare” professionals that will take over from the primary care trusts from April, and they will be responsible for designing local health care services in England.
They will be commissioning or buying health care services such as:
- ElectiveHospital Care.
- Rehabilitation Care.
- Urgent and Emergency Care.
- Most Community Services
- Mental Health and Learning Disability Services.
All GP’s practices in England, under the Health and Social Care Act 2012, are required to be members of a CCG. The aim is to give GP’s and other clinicians the power to influence the commissioning of the health needs of their patients. Here is the thing, and something that is quite concerning, the CCG’s will be responsible for the entire NHS budget of some £65 BILLION.
It is the biggest single change to the NHS since it’s creation in 1948.
It’s important to note and understand the changes that we face. The CCG’s have been framed as being significantly different to their commissioning predecessor the PCT’s because they will hand a larger role to the GP’s. The CCG’s, need to focus on the value that the clinicians bring to commissioning.
Focus should be on clinical risk, and how clinical risk is managed when deferring services from a hospital to community setting. Attention needs also to be given to defining population health needs, so that commissioning intentions are properly handled and clearly defined,
Am I worried?
Yes. Why? Well, firstly, CCG’s will be relatively young organisations that need time to grow, many have challenging times ahead. Secondly, CCG membership has a mix of clinicians, managers and lay people to represent patients. It should also be pointed out that many CCG’s are being led by GP’s, who are able to give a day or two a week of their time to the CCG’s the rest of the time they are in their own practices. What concerns me is that there is a risk that the clinical voice will not be as prominent in the commissioning decisions, and managers with no clinical experience will be making decisions based on our health needs.
So why the upheaval then?
CCG’s, if clinically lead, not management lead, can be a producer for patients and the population. In 2013/14, financial year, it promises to be very tough for the NHS, and CCG’s will need to make some TOUGH COMISSIONING decisions. THIS WILL AFFECT YOU.
This will mean, moving services outside the hospital setting (more hospitals to close then) consolidating services, on fewer sites, (which means longer travel to different areas for all of you) and stopping some services altogether, (which means you will find that certain medications will be stopped, you cannot have that operation, you will be removed from the list with no warning, only to be told, the criteria has changed and you now do not meet it.)
With less than 4 months to go before CCG’s formally take over from primary care trusts, just eight of the of the 211 CCG’s are fully authorised by the NHS Commissioning group to begin in their work. After a five month assessment no fewer than 119 were not tested, a further 26 CCGs in the first wave of the New Year have been attached with conditions.
3 more waves of CCG’s are authorised to follow in the New Year. Many of the CCG’s are beset by serious problems that are in these first waves that showed as having significant, unstable financial and effective governance problems.
Managers working in both the PCT’s and CCG’s, have seen many CCG boards struggle with strategic planning; PCT’s were set up to cover whole population areas. In some ways they had the opposite problems to that now experienced by the CCG’s. The outgoing PCT’s were good at the big picture but struggled to get down to a granular understanding of population need. GP’s have a detailed understanding of the health needs of patients but are not used to planning across the big population needs.
There are widespread concerns about governance. Through no fault of their own, GP’s leading the CCG’s have been thrust into a position where they are at constant risk of conflicts of interest, and many of them do not seem to understand the critical importance of robust advice and establishing procedures to ensure they cannot be accused of improper conduct.
Crucially, some have not grasped that is not just whether you intend to do anything wrong for that matter, it is able to determine that you are squeaky clean.
A GP source told me in Welling Kent, that he will be paid £5 per patient in their practice to slash the number of patients they refer to hospital. GP’s are to be offered financial incentives if they meet targets to reduce referrals. Every time a doctor sends a patient to hospital for a scan, consultation, or operation, the local NHS trust is charged for the cost of that patient’s treatment.
The trusts are trying to save money by urging GP’s to cut the number of so called “Inappropriate referrals”
But leading doctors, including members of the BMA, say it’s unethical to pay doctors for effectively withholding treatment.
Dr Laurence Bickleman, Chairman of the GP committee of the BMA said, “There is no way that paying doctors for withdrawing treatment is acceptable”
This brings up a concern I made earlier, about the CCG’s and GP’s as this would produce obvious conflict of interest.
You cannot ever have a patient in front of you if it’s in your interests to treat them.
He said, “I have yet to find, anyone who thinks this is a good idea, I don’t see overall enthusiasm for this” “I am very concerned” he said, that these schemes are happening.
So, for example, an idea of the scheme is this. How would say £26,000 a year in extra funding for the practice work?
Well, under a scheme proposed by Harrow PCT in North West London, doctors have been promised £4 for every patient in their practice if they follow certain steps aimed at cutting referrals.
The amount of money each practice gets depends on the number of patients on its books, and whether it meets all of the “referral” targets that are set by CCG’s.
To get the full amount, practices must allow a number of steps which include reducing their referrals by 10%.
They must draw up lists, giving the details of the names of the patient referred, the reasons why they were sent to hospital and which GP ordered it.
Then, the practice must also nominate a GP, to scrutinize every patient referral to hospital to ensure they are “appropriate”. The scheme covers referrals ranging from patients sent for scans, to rule out possible Cancer, to those needing to see specialists for a hip and knee operation.
If a practice meets all the criteria it will be £4 for every patient not referred to hospital on its books. If it only meets certain fulfilments it may just get £1 or 2 per patient.
All average sized practices roughly have 6,500 on their books. So they stand to earn a maximum of £26,000 a year of additional funding by this method provided but as long as it meets all the targets.
Doctors could then decide, “ TO SPEND THE MONEY AS THEY WISHED” on better facilities for the surgery, or “TO INCREASE THEIR OWN SALARIES” !
A surgery with 6,500 likely to send between 650 and 1,300 patients for referrals to hospital a year. Harrow PCT insisted that the scheme was meant to be in patients “best interest” and that they are more likely to improve care whilst saving the NHS money”.
At Hardwick Clinical Commissioning group in Derbyshire the practices are offered 25p per patient up to 1,600 in total if they cut referrals. Luton PCT in Bedford, is also proposing to offer practices extra funding to cut referrals, though details are not available to post here.
Although, the NHS has been protected from the cuts to its budget, it has been ordered to make £20 BILLIONSAVINGS by 2014. By running more effectively.
Whitehall and dear old David Cameron, say the savings are necessary to ensure there is enough money to care for all the elderly population. Explain to me, Mr Cameron, the care pathway where 60,000 people are on the care pathway without their knowledge or that of the families and the doctors can withhold treatment from the patient. What happens? That patient can and will die. Mr Hunt, thinks the care pathway is “a bright and good idea” what killing off thousands of patients Mr Hunt? Euthanasia?
Frightening and worrying and down right petrifying what this government are about don’t you think?
It must also be pointed out that many trusts have resorted to try and slash referrals by rationing of treatment in certain trusts and cutting back on the number of staff. Some trusts are trying to reduce spending by sending some patients to other surgeries that offer specialist services such as physiotherapy rather than sending them to hospital because it’s cheaper.
Doctors are arguing that the 2012 Health and Social Care Act “will lead to the abolition of the NHS in England”and fallible the transition from a single pay financed system to a mixed funding system (PRIVATE HEALTH CARE INSURANCE.) with increasing privatisation of the provision and commissioning of health care in England.
Here are some thoughts to make you think and chew over as I try to bring this article to its end.
When you go to see a GP and they say you don’t need to see a consultant and certain medication will no longer be available, be sure whether that decision is because it’s best for you or because the GP has their eyes on a new car or nice holiday, (I talked about the financial incentives earlier.)
When it takes longer to get an appointment with the GP, or you can’t pre book one, it’s because the GP are in meetings with staff from companies like KPMG (who in turn are owned by ATOS) who are making their commissioning plans for the CCG’s to rubber stamp.
How many GP’s will know enough to challenge the advice of the “experts” with their flow charts and glossy colourful brochures?
If you want to challenge the plans, you’ll find that the CCGS that YOUR PRACTICE is part of has decided that the meetings about such IMPORTANT THINGS must happen IN PRIVATE.
If your GP does say you need to see a consultant, you will find a really long wait, waiting times to see a consultant in ENGLAND have risen by 34 per cent in the last two years since the condems have come into power in 2010. This is because your local hospital will be selling as much as 50 per cent of its capacity to private providers. This is something that is already happening that all NHS Trusts will need to doing just to balance their books especially as public money on the system is reduced year on year.
If your care requires collaboration then you’ll find it can’t happen because parts of the care path are now being run by private companies who are different system and planning services, in that they could be seen as anti competitive. The experts are still arguing whether the system known as “any qualified provider” means decisions about working together can be challenged using European Competitiveness.
GP’s won’t know that the big money deep pockets of the private providers are lining to exploit uncertainty. And are rich enough to challenge every commissioning decision they just well, do not like.
If you have a specialist need you will find you can no longer use your local hospital because your clinical commissioning group has contracted each condition to a different private service which for efficiency, serve large areas and are located 50 miles away.
Some of the first services contracted out were maternity services and my trust in South London knows all about that, with the closure of the maternity department at Queen Mary’s Hospital in Sidcup in 2010, and Lewisham Hospital about to lose theirs. It will mean that there are two maternity departments for Lewisham, Bromley Bexley and Greenwich. These four boroughs serve over 1.5 million people.
In the longer term, you’ll find a system in which doctors and nurses become increasingly scarce and are not keeping their skills up to date, because the system of teaching hospitals has broken down and private providers don’t like to spend profits on teaching their doctors, it goes on the share holders, people with vested interests in private health care companies.
People like DAVID CAMERON, GEORGE OSBOURNE, IAIN DUNCAN SMITH, DAVID MILLIBAND, across all three parties and the Lords, well they all profit too!
The Strategic Health Authority who currently manage the commissioning and provision of training and on setting developments will be abolished in a couple of years and the health bill currently has no plan in it to replace that function.
Heath Education England is still, well, JUST A NAME.
The question of WHICH practice you register with will be a lot more crucial as this will determine which clinical commissioning group will be paying for any care you need.
Health will no longer be planned on the services of needs of a locality but on the basis of the BUSINESS PLAN for the collection of practices.
The budget can be used for patients who suddenly need a £70,000 heart transplant, If the balance is disturbed then services where young fit patients will protect their profits whilst those servicing ill patients will have to RATION treatment, or go BUST like a hospital.
We don’t know how the system will stand up when there is an epidemic or health crisis because the whole public system of public health is to be re organised in new lines and SHA and PCTs that formerly planned for this and co coordinated the system response to crises are being broken apart and abolished.
And when all this goes wrong you are likely to find that the Secretary of State for health will step back, and claim “my hands are tied” and it “is now out of their control” because the traditional accountability replied on for over 60 years has been removed, and the lawyers and politicians are still arguing over this.
Keep this in mind, that in 2009, Jeremy Hunt, called the NHS “a 60 year old expensive mistake”, and David Cameron in the same year called it “a soviet style calamity”. They do not want the NHS to exist. David Cameron lines his pockets with profits from private health care companies.
OPEN YOUR EYES. SEE THIS GOVERNMENT FOR WHAT IT REALLY IS, CORRUPT and WRONG!
The NHS was not broken in the first place, the case for change was NOT backed by evidence. Yes, it can be improved upon and times are changing, but we still want the NHS to be kept public, and publicly accountable. I know I for one want the NHS.
Do you? What’s that saying? If it aint broke don’t fix it.
You need to understand this; when the NHS is gone, it’s gone. These changes will not be reversed.
The majority of Britons have been born and grew up with a health service that was for the public good rather than for private profit. It was strategically managed in all our cases. Mostly, we take it for granted, that it is there when we need it, the rest of the time we don’t think much about it at all.
With the clinical commissioning groups hundreds of GP’s when they signed up to the constitution only a while ago, were being asked to sign legal agreements from speaking out about the clinical commissioning groups and what happens. They forbid the GPs from speaking out in public about the clinical commissioning groups. If a GP wishes to say something, they have to get written permission from every member of the group.
So GP’s have been gagged.
You have read this and think- what the….but every word of it is true.
You know, I have been called a scaremonger and a lot worse abusive names for voicing my concerns about the NHS.
All I can say and one day when you need it and then it will be too late, because it will be too late then and these changes that I have talked about for these many months, are now a cold hard reality.
Just one last thought, have you all noticed the flood of ads for private healthcare insurance on TV and everywhere you look? Now do you see where this is going?
Can you afford private health care insurance?
That most pre existing conditions are not covered or premiums will be loaded? 99 per cent of people in this country can’t afford it.
Now you have read this open your eyes. This is 21st Century Britain. This is what is happening to the NHS.
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Article written by PAULA PETERS.
Published online at: http://socialwelfareunion.org/archives/2954
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