STPs: Privatisation and digital "self-care"

STPs must “encourage” long term NHS “partnerships” with the private sector


Since the Autumn 2015 Comprehensive Spending Review that created the Sustainability and Transformation Fund, both the government and NHS England have explicitly linked the Sustainability and Transformation Plans to the requirement to “encourage” increased private sector involvement in the NHS.

Some key aspects of STPs’ mandatory “encouragement” of long term NHS “partnerships” with the private sector include

  • Strategic partnerships with the NHS and the 39 Local Economic Partnerships.
  • The abandonment of  “old-style contracting” and the  imposition of private company-friendly contracting.
  • Embedding digital technology in STPs.


Strategic partnerships with the NHS and the 39 Local Economic Partnerships

This aspect of Sustainability and Transformation Plans seems to be enthusiastically driven by the NHS Confederation – the trade association for private health companies with NHS contracts.

It involves increased privatisation and public/private partnerships between a vast range of NHS commissioners and providers, private health companies, voluntary and community sector organisations and a range of other companies, as health and social care services are harnessed to Local Economic Partnerships as a vehicle of economic growth and a way of securing “external investment” in the NHS through “a host of new finance mechanisms”.

According to the NHS Confederation, which describes itself as a network of NHS “partners” – i.e. private companies – the aim is to “match fund” NHS England’s 5 Year Forward View – the plan behind the STPs.

This is staggering. They are talking about £hundreds of billions of private sector money coming into the NHS so it will no longer be a publicly funded, owned and managed health service.

This is ALL being done by stealth.

This move is supported – again by stealth – by a recent outrageous letter from NHS Providers – the trade association of NHS Trusts & Foundation Trusts – to The House of Commons Select Committee. The letter called for an inquiry that will change the NHS policy framework to bring it in line with STP – driven withdrawal and/or restrictions of a variety of treatments.

The NHS Providers say this is being done in contravention of the current NHS policy framework of a comprehensive service that is free at the point of clinical need for all patients that have a clinical need for it.

NHS Providers are asking for an inquiry that will recommend policy changes that will effectively end the NHS and turn it into a brand for a public/private partnership operating along the lines of the US health digitech and insurance companies – Cerner and United Health, respectively – that previously employed NHS England head honchos Mathew Swindells and Simon Stevens.

The abandonment of  “old-style contracting” and the  imposition of Cerner and United Health-friendly contracting

Matthew Swindells recently told Clinical Commissioning Groups to abandon “old style” contracting  . What will replace the “old style” contracting – the current system of commissioning and providing NHS and social care services – is  Accountable Care Organisations (ACOs).

ACOs are a form of public-private partnership.  Think Private Finance Initiative, but for NHS services as well as buildings. The hot favourite ACO model  – plugged by the pro-privatisation think tank the Kings Fund  in  a health system redisorganisation “masterclass” on 12 October – is South Central Alaska.

Cerner is behind the Kings Fund’s promotion of South Central Alaska ACO as the new STP form of contracting. The company commissioned the Kings Fund report that plugs the South Central Alaska ACO, with the brief to:

“write a report analysing how an intentional whole health system redesign can deliver better health outcomes to a population. The report, based on independent research conducted by The King’s Fund, focuses on Southcentral Foundation”

Delivering better health outcomes to a population sounds like a good goal.

There are just two problems.

There seems to be no reliable evidence that this model of ‘integrating care’ will reduce costs or improve patients’ health.

And there seems to be little faith  that it can actually be delivered on the ground. Dr Robert Morley, the Chief Executive of  Birmingham GPs’ Local Medical Committee says this model of care is ‘simply undeliverable’:

‘The STP, and in particular the plans to massively increase the delivery of out-of-hospital care, to transform general practice and to give it far greater responsibilities across a range of areas are simply undeliverable bearing in mind the meagre additional investment, the unambitious plans to increase primary care workforce and the woefully inadequate intention to support general practice sustainability and viability.’

 So what is driving these ideas? And what are they really designed to achieve?

Clues leak out in the STPs – and earlier documents like Calderdale and Greater Huddersfield’s “Right Care Right Place Right Time” NHS and social care reconfiguration documents and the 2014  Better Care Fund Submission from Calderdale Council and Calderdale Clinical Commissioning Group.

These proposals will ‘create a responsive local market’ for health and social care.  They will also ‘reduce the pay bill’ and make increased use of patients’ self management as well as “business-ready” voluntary sector organisations in the new “locality-based” integrated teams.  These are themselves likely to be privatised – with tax avoiding Virgin Care are a contentious front runner that has just mopped up a £700m contract to run Health and Adults Social Care in Bath and NE Somerset.

Embedding digital technology in Sustainability and Transformation Plans

The STPs’ “new models of care” are all dependent on a hugely increased use of health digital technology.  Health information systems apparently will deliver a $53 billion market globally in 2019 because of vaguely defined proposals for ‘integrated care’ and ‘care closer to home’. Good news for marketeers, bad news for patients and NHS staff .

This is the route to turning patients into consumers,  who dispose of a mix of NHS personal health budgets and – if they can afford it – top ups paid for out of their own purse. So, it is the route to a two tier NHS – like the already totally marketised two tier social care system. And the money the patients/consumers spend goes directly to digitech companies like Cerner.

This is at the say-so of Matthew Swindells, previously Vice President of US health digitech company Cerner, now NHSE National Director for Commissioning Operations and Information

At the September 2016 NHS Expo – a business-sponsored event plugging the wonders of privatisation via personal health budgets and a bonanza for big pharma and big digitech –  Matthew Swindells announced that digital technology must be embedded in Sustainability and Transformation Plans.

New STP Digital excellence centres – also announced at NHS Expo – promote patients’ use of smartphones and mobile devices. The Acute Trusts that are centres of digital excellence will set up digital technology so that patients can access more services via smartphones and mobile devices.

This ties in with the so-called Care Closer to Home scheme that copies the model for “demand management” used by the American private health care company, Kaiser Permanente.

It requires 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 to specialist nurses and/or GPs.

The aim is to target care without relying on expensive personal contact between doctors/nurses and patients as a way of checking on patients’ health.

The system would also direct behaviour change incentives and messages to people statistically at risk of developing various illnesses. This aims to reduce the likelihood that they will become ill.

But there’s little evidence that this actually works.

And it looks as if a lot of the much-vaunted increase in NHS funding via the Sustainability and Transformation Fund, is going straight into the pockets of digitech companies like Matthew Swindell’s former employer.

Here is what Cerner has to say   about the kind of health digitech that the £100M Digital Excellence Fund is going to pay for:

“Cerner has several exciting projects and relationships related to some key aggregation platforms, including Apple and Validic, which are on the augmented self-management end of the remote monitoring spectrum, and Qualcomm Life, which is active monitoring. Cerner also has a relationship with Livongo to improve outcomes for diabetics. These relationships will increase the ability for Cerner clients to track their patients remotely, whether to manage chronic conditions through a prescribed device or kit, or through an ecosystem of apps enabling patients to manage their day-to-day health.”

The NHS England panel that chose which Trusts to award the centres of digital excellence funds to was apparently led by Professor Keith McNeil, NHS England’s first chief clinical information officer, who reports to Matthew Swindells.

And Simon Stevens had previously announced at the 2016 NHS Confederation conference  that:

“…from April next year, we will add a piece to the national tariff system specifically for new med tech innovations that have been shown to be cost-saving or help patients with supported self-management.”

This sounds a lot like a repeat of Tony Blair’s NHS Programme for IT (NHSPfiT), which pretty much ended in tears. Is the STP Digital Excellence scheme going to do any better? And will it even matter to the revolving door merchants Simon Stevens and Matthew Swindells, who are pushing it? After all, as Stuart Player and Colin Leys wrote in 2010 :

“…the plan to turn the National Health Service into a healthcare market does not rest on rational arguments but material interests… the plans are not really new, but are the culmination of a decade-long campaign by the private health industry to get its hands on the NHS budget.”

And that is what the STPs are really about:  cuts, privatisation, and a paradoxical central control over “devolved”, fragmented public/private NHS and social care.


Social care services 'facing existential crisis', say council leaders

Rising costs, ageing population, staff recruitment difficulties and years of cuts have left service in crisis, LGA report claims

Councils will have to continue reducing at-home support for older people, according to the Local Government Association.


Social care services that support elderly and disabled people are facing “an existential crisis” despite being as important to national well being as the NHS, council leaders will claim on Wednesday.

Councils will have to continue reducing at-home support for older people and paying for beds in care homes because of Whitehall budget cuts, according to the Local Government Association.

Rising costs, the ageing population, difficulties recruiting staff and years of central government reducing its grant have left the service in crisis, the cross-party body claims in a new report.

Councils have had to provide less care at a time of growing need, leaving more vulnerable people isolated and at risk, it says.

Philip Hammond, the chancellor, must recognise the “perilous” state social care is now in and ease the pressures on it when he delivers his autumn statement on 23 November, says the LGA, which represents 370 councils in England and Wales.

“The situation is now critical and it is no exaggeration to say that our care and support system is in crisis,” said Izzi Seccombe, chair of the LGA’s community wellbeing board and the Conservative leader of Warwickshire county council.

“For too long the service has too often been seen by decision-makers as an adjunct to the NHS, rather than a service of equal importance,” she added. Theresa May needed to deliver on her promise of building “a country that works for everyone” as prime minister to avoid the sector suffering even more damage, she said.

The LGA’s intervention comes after a host of NHS leaders, including the NHS England chief executive, Simon Stevens, made clear that if Hammond does produce more money in the autumn statement for the health service, it should go instead to prop up social care.

Richard Humphries, a social care expert at the King’s Fund, said: “It defies all sense and reason that social care spending will slip back to less than 1% of GDP by the end of the parliament when the number of older and disabled people is increasing and demand for services is rising. This is an unsustainable situation.”

The Care Quality Commission said last month that social care was approaching “a tipping point” meaning even fewer people would get care they need and the NHS would become even busier, unless ministers came up with some solutions.

“Bed blocking” stands at record levels and is costing hospitals £800m a year because mainly elderly patients who are fit to leave cannot be safely discharged because social care support is lacking.

A Department of Health spokeswoman defended the government’s record on social care, saying: “This government is committed to ensuring older people throughout the country get affordable and dignified care. That is why we are significantly increasing the amount of money local authorities have access to for social care, by up to £3.5bn by 2020.”  [But only if the Local Authorities raise an additional precept of up to 2% through Council Tax - which many are reluctant to do].


Four in five UK councils struggle to provide older people's care – survey

More than 6.4 million people aged 65 and over live in areas without enough care to meet demand – especially specialist dementia care, says research

The north-east was the only area where more than half of the local authorities surveyed reported sufficient care.

The Family and Childcare Trust surveyed councils across the country and found they are struggling to meet needs amid a background of growing demand, budget cuts and recruitment difficulties.

The survey is published on the same day as an undercover investigation by BBC Panorama is to be broadcast, exposing shocking neglect at two Cornwall care homes   [Panorama: Nursing Homes Undercover broadcast on BBC1 on Monday 21 November at 8.30pm] including vulnerable people being left unattended and a nurse saying she will use morphine to “shut up” a resident.

The deficit identified by the Family and Childcare Trust means more than 6.4 million people aged 65 and over are living in areas that do not have enough older people’s care to meet demand.

Only one in five councils reported having enough older people’s care in their area to meet demand, the survey found.

Just under half (48%) of the 182 councils (out of 211) that responded said they had sufficient availability of home care and a similar proportion (44%) reported having enough places in extra care homes, which allow people to live independently with 24-hour emergency or on-site support.

Only a third of local authorities said they have enough nursing homes with specialist support for dementia, which is predicted to affect one million people in the UK by 2025.

Claire Harding, head of research at the Family and Childcare Trust, which works closely with the government and local authorities, said: “It is inexcusable that vulnerable people are left unable to find the care that they need.

“We urge government to make sure there is enough care for everyone who needs it. In order to do this, we need robust data on where there are gaps in care, a funding system that truly meets the cost of providing care, and clear information for families.

“Without these steps, families will continue to struggle to find care and to meet the numerous care costs on their shoulders.”

The survey also highlighted large regional variations, with just 7% of outer London councils reporting enough older people’s care to meet demand. The only area where more than half of local authorities reported sufficient care was the north-east, where 57% responded positively.

The findings will add to the sense of crisis surrounding social care, with delayed transfers of care – when patients are medically fit to leave hospital but unable to be safely discharged – at record levels.

Council and NHS leaders, as well as the Care Quality Commission, have called for urgent action, with the chancellor, Philip Hammond, facing pressure to increase social funding in Wednesday’s autumn statement.

Inner London councils pay the highest rates for residential care for older people, at £649 a week per place, compared with the lowest rate of £464 in north-west England, according to the survey. The UK average for a residential place was revealed to be £27,113 a year.

A Department of Health spokeswoman said: “This government is committed to making sure older people throughout the country get affordable and dignified care. That is why we are significantly increasing the amount of money local authorities have access to for social care, by up to £3.5bn by 2020.”

Monday’s Panorama sees reporters go undercover at Clinton House in St Austell, and St Theresa’s, in Callington, near Plymouth, both owned by the Morleigh Group.

Hidden camera footage captured one resident left on a bed pan for 40 minutes and an out-of-date prescription supplement relabelled for use by another resident.

Clinton House is being closed as a result of safety concerns and St Theresa’s is under investigation by authorities along with two other Moreleigh Group homes.

Moreleigh Group said it had already removed the staff involved and reviewed its systems and procedures, prior to receiving information from Panorma. Cornwall council apologised for the failings.