Internal market

  • Manifesto: Tories open to legislation to curb internal market

    From Health Service Journal - 18th May 2017

     

    The Conservative manifesto says the party is open to introducing health legislation if the NHS’s leaders ask for it to help deliver the Five Year Forward View, for example to create new integrated care models.

    It also commits to “review the operation of the internal market and, in time for the start of the 2018 financial year, we will make non-legislative changes to remove barriers to the integration of care”.

    Health secretary Jeremy Hunt told HSJ that the “internal market is too bureaucratic”, and indicated that changes could include a shift to capitation funding, under which providers receive budgets for the care of their entire population, eliminating some commissioner functions.

    The manifesto states: “We will hold NHS England’s leaders to account for delivering their plan to improve patient care.

    “If the current legislative landscape is either slowing implementation or preventing clear national or local accountability, we will consult and make the necessary legislative changes.

    “This includes the NHS’s own internal market, which can fail to act in the interests of patients and creates costly bureaucracy.”

    Over the past year senior NHS figures, including NHS England chief executive Simon Stevens, have indicated that parts of current NHS legislation, including the Health Act 2012, can make it more difficult to develop integrated care and new contracting and organisational models.

    Potential options for legal change range from changing competition and/or procurement law; merging NHS England and NHS Improvement, and potentially other quangos; to creating new NHS structures locally or regionally – potentially eliminating or dramatically reforming the commissioner/provider split.

    The NHS has begun work on developing accountable care structures, but is at a relatively early stage. Many of those involved see it as very difficult within current legislation and rules.

    NHS England is currently working to prepare to announce next steps for the NHS’s first “accountable care systems” shortly after the general election, with up to nine areas of the country

    Comment:   Abolishing the market and purchaser/provider split once new Accountable Care Organisations are in place will cement the regional nature of ACOs and will facilitate capitated funding.  The final step in the regionalization and privatization of the NHS will have been completed.

  • Hugely successful demonstration by NHS campaigners in central London on 4th March 2017

    They came from all over the country united in their concern for the present state of the NHS and their fears for its future. Different sources estimate attendance from "tens of thousands" to 250,000.

    Three women dress in white medical suits and hold placards reading 'Slash Trash Privatise', 'Don't be a Silent Witness' and 'Death Closer to Home' near Russel Square today. The protesters are set to be rallied by Bernie Sanders's brother

    From "Save Our Services Cumbria" (Whitehaven Hospital), to "Hands off Huddersfield Royal Infirmary", to "Calderdale 999Call for the NHS" (above), to "Defend our NHS York", to "Bristol Protect our NHS", to "Sussex Defend the NHS", all were protesting about planned or actual A&E, acute units or whole hospitals closures. Health Campaigns Together  and the People's Assembly had done a superb job calling together dozens of NHS campaign groups and organizing the biggest NHS demonstration in central London in decades.

  • The internal market: The billions of wasted NHS cash no-one wants to mention

    by Caroline Molloy  - published 10th October 2014 in OpenDemocracy/OurNHS....

    .....and STILL relevant

     

    As calls mount for the NHS cash crisis to be 'solved' by charging patients, there is one pot of money that sits glistening and untouched...

    Calls to solve the NHS cash crisis by charging patients have mounted this week, with the NHS Confederation calling for £75 a night ‘hotel fees’ for hospital stays, or much longer waiting lists.

    But there is one pot of money that sits curiously unexamined, glistening and untouched.

    It’s the cost of the NHS ‘market’ itself. Administering the hugely expensive artificial ‘marketplace’ created by successive governments to allow both NHS and private ‘providers’ to compete with each other to offer services to NHS and other ‘purchasers’.

    No-one knows the exact cost of this bureaucratic ‘marketplace’. A recent estimate by rebel Lib Dems put the figure as high as £30billion a year. Dr Jacky Davis and other doctors and campaigners including the National Health Action Party have put it at £10billion a year. The Centre of Health & the Public Interest put it at a ‘conservative’ £4.5billion a year.

    Even the most conservative of these estimates is a yearly amount which would, if re-directed away from useless market activities, fund both the £2billion annual NHS shortfall and free critical social care to everyone, which the Kings Fund’s Barker Commission recently said would cost  ‘substantially less’ than £3billion a year.

    Despite fierce urging from expert MPs to look at what the ‘market’ costs the NHS more closely, the government, mainstream media, think tanks and policy makers have dismissed, ignored and even suppressed this information, with unevidenced assertions that ‘modern healthcare systems’ need vastly expensive bureaucracy, market or no market.

    Successive governments wedded to ‘market reform’ have refused to produce useful figures that would definitively establish the cost of the NHS market. It has been left to academics, MPs and activists to try and fill the void, through historical and international comparisons, as well as tentative attempts to cost different activities that are forced on the NHS by the ‘market’.

     

    Hiding the figures

    In 2010 the Health Select Committee found that running the NHS as a ‘market’ cost the NHS 14% of its budget a year.

  • "At what cost? Paying the price for the (internal) market in the English NHS" by Prof Calum Paton

    This is a paper published by the Centre for Health and the Public Interestin February 2014: a seminal and excoriating indictment of the "evidence-free" policies of successive Governments in England.

    Calum Paton is now Professor of Public Policy at Keele University, where he has been Professor of Health.

     

    1. Extreme financial pressure upon the English NHS for the foreseeable future makes avoidance of waste imperative. The 'market' in the NHS is a major source of waste.Creating and maintaining markets has incurred huge direct costs and significant 'opportunity costs' – money which could have spent upon patient care and clinical re-design.

    2. Not only has evidence to justify 'market reforms' to the English NHS from 1990 to the present-day been absent, but the recent Health and Social Care Act of 2012 actually ignores, or even inverts, evidence which suggests that 'commissioning' by GPs in local markets characterised by separate 'purchasers' and 'providers' is costly and of dubious effectiveness. The only reasonable conclusion is that that market policy is based upon ideological dogma, pressure from commercial interests or both.

    3. It has been argued that the only way in which hospitals and other service providers can be reimbursed in a timely manner for their workload, and given the incentive to increase workload and productivity, is through the operation of market forces. This is simply untrue and based on a re-writing of history.

    4. The recurrent, annual costs of the market can be estimated (conservatively) at £4.5 billion.

    5. The one-off, start-up costs of the various phases of the market (1991-97; 2001-2007; 2010 to date) have run into billions of pounds, with (again, conservative) estimates of the most recent market initiatives under New Labour and then the Coalition government comprising £3 billion each.

    6. This paper sets out how the wider costs of the market have included both opportunities foregone and likely harm to the system.

    7. Possible benefits from the market are hotly contested in the research community and – even if one grants the benefits claimed by supporters of the market – very small when set against the costs.

    8. It would take ideological chutzpah of the most irresponsible sort to suggest that the answer to the failure of the market so far is 'more market'. The paper suggests why.

    9. It is possible to have patient choice and high-quality health-care without the market. The paper suggests how.

  • "How to Dismantle the NHS in 10 Easy Steps" by Dr Youssef El-Gingihy, an East London GP. 978-1-78535-045-0 Zero Books

     

     

    In 70 pages this slim volume sets out in 10 chapters the legislative changes and the 30-years history of creeping privatization which are crippling our NHS.

    The main points are:


    - In the 1980s the NHS internal market was introduced: Primary Care Trusts as "purchasers" and NHS hospitals trusts as "providers". The politicians wanted "competition" despite all medics saying that what you really need in healthcare is collaboration rather than competition.

    - At about the same time John Major introduced PFI deals for new hospitals, there which makes the final bill for a new hospital at least 7 times the original cost (and sometimes up to 50 times!) And it comes with strings for expensive "facilities management" (maintenance).

    - Corporate takeover:
    Primary Care Trusts could commission care from Alternative Providers of Medical Services, i.e. companies employing salaried GPs (e.g . United Healthcare, Atos and Virgin). Out-of-Hours care contracts were won by Harmoni, Serco and Take Care Now.

    - From 2003 hospital trusts could become "Foundation Trusts": this meant that they became financially free-standing, independent businesses. But with that came intense pressure to cut costs, leading to dangerously low staffing levels at Mid Staffs.

    - A "Payments by results" - a national tariff of fixed prices - was introduced. Since 2010 the Gov has reduced (by 3% year on year), not increased, the prices paid for each completed treatment despite the increase in population and the average age of the population. Revenue to hospitals could only increase if hospital doctors completed more and more treatments. And of course admin costs soared. Hospitals and doctors were working harder and harder to push more patients through.

    - The reduced tariffs and the freeze on all medical salaries for 5 years has produced "efficiency gains" - but at the cost of exhausted and frightened medical and management teams, and dangerously unstable finances (collapse of South London hospitals trust and the near-loss of Lewisham hospital).

    - To plug the gaps in staffing hospitals trusts have paid through the nose to agencies for temporary staff.

    - What incentive is there for even the most dedicated registrar to stay in a system which is demonstrably financially unstable?

    - In an attempt to meet the targets and understand the new environment, hospitals trusts have employed expensive management consultants to guide them - draining even more money out of their budgets.

    - In a move related to uncontrolled immigration not to NHS problems, the Home Office is refusing to renew visas of non-EU nurses if they are not earning at least £35K after 3 years. More fees to agencies.....

    - It seems very likely that "personal health budgets" for social care will be extended into medical care, and then "co-funding", and then... private medical insurance will be essential to ensure adequate medical care. "Free NHS care at the point of delivery" will have finally gone!!!

     

    I would add some other points:

    - There is ample evidence that Jeremy Hunt, Virginia Bottomley, Stephen Dorrell, Patricia Hewett and many members of present and past Conservative and Labour governments have had or still have financial links to private providers to the NHS. The "revolving door" between a senior cabinet appointment and directorship in the private health sector is active. The present CEO of the NHS, Simon Stevens, is a life-long health manager, but he spent 10 years working in CEO roles for United Health Group companies in the US.

    - It also seems very likely that the new and very complex contracts with private companies will provide plenty of opportunities for healthcare fraud at the expense of the patient. Fraud is difficult to detect and expensive to prosecute.

     

  • TTIP and its impact on the NHS and health - Linda Kaucher of StopTTIP

    StopTTIP meeting public information meeting focused on NHS/TTIP. Monday 3rd Feb 2014 6.30-8.30 pm, UNITE building.

    Within the EU and US civil society mobilisation against the TTIP, there is a particularly UK campaign calling for an exemption of the NHS from the TTIP.

    This is not an abandonment of a call to end TTIP negotiations or saying that an NHS exemption is enough.

    The NHS, and the changes to it, are a main public concern in the UK. Trade agreements like TTIP seem remote and unrelated to people’s lives, and importantly go unreported. However, it is clear that people can understand quite easily how the TTIP will make the provisions of the Health and Social Care Act permanent.