Private firms receive £2.3m to draw up STP plan for North Central London

Peter Blackburn for BMA 19th January 2017

 

Private firms have been paid a ‘shocking’ £2.3m to draw up controversial plans which will cut health and social care spending by more than £1bn in a part of London.

According to health leaders drawing up the North Central London STP (sustainability and transformation plan), six-figure sums were paid to eight different companies – including accountants Deloitte and management consultants McKinsey – for services stretching from ‘administrative support’ and ‘financial modelling’ to ‘communications support’.

A firm called Consultants Methods Advisory Ltd, which describes itself as ‘shaping public services for the digital age’, racked up the biggest costs, invoicing £617,850 for ‘programme management office and strategy support’.

Doctors leaders described the figures as ‘appalling’.

BMA council chair Mark Porter said: ‘While hospitals fall into crisis, social care hits rock bottom and the Government blames hard-working GPs for its political choice to underfund the NHS, every penny of health service money becomes more desperately valuable and doctors will find it galling to see that so much vital resource has been handed to consultancy firms for their part in failing plans which, ultimately, may never come to fruition, while frontline staff struggle to provide safe patient care in a service increasingly becoming unfit for purpose.’

 

Pick and choose

Read more ...

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.

Read more ...

NAO report on health and social care integration 8th Feb 2017

 

For the last two years (since April 2014) NHS England has run a number of experiments (called "Pioneer" programmes), including in NW London, to try to integrate health (hospital) and social care, which is essential for reducing demand for hospital services and is a central part of "Sustainability and Transformation Plans" for the 44 "footprints" of England.

The National Audit Office published its findings on Wednesday 8th Feb. It said: "Integrating the health and social care sectors is a significant challenge in normal times, let alone times when both sectors are under such severe pressure. So far, benefits have fallen far short of plans, despite much effort." "Nearly 20 years of initiatives to join up health and social care by successive governments has not led to system-wide integrated services" "The Departments [of Health and Local Government] have not yet established a robust evidence base to show that integration leads to better outcomes for patients" and finally "There is no compelling evidence to show that integration in England leads to sustainable financial savings or reduced hospital activity".

Trying to mix health and social care is like trying to mix oil and water, due to the different funding and cultures.

See NAO report: https://www.nao.org.uk/wp-content/uploads/2017/02/Health-and-social-care-integration.pdf
And BBC news: http://www.bbc.co.uk/news/health-38894593

 

STP finance figures in spreadsheets and Delivery Plan "incorrect" - or not?

At a presentation to Kensington and Chelsea Healthwatch members and residents on Tuesday 31st January, the STP team were challenged by Merril Hammer, Chair of Save Our Hospitals, about the figures revealed recently by a FOI request to NW London CCGs. The finance figures were contained in a "workbook", a set of spreadsheeets submitted with the Oct 2016 STP. Merril referred to the plans for the loss of 3,658 NHS jobs in NW London next year 17/18, rising to 7,753 job losses by 20/21.

When NHSE, an executive body of the Dept of Health, publishes information, especially as a result of a Freedom of Information request, the public has a right to be able to rely on its contents.

But in the question and answer session Christian Cubbitt, Director of Communications for NHS NW London Collaboration of CCGs, publicly retracted the figures. He said that they were "incorrect" and that there would not be nearly 8,000 job losses. He said that the "correct" figures would be produced, but did not give any deadline.

Given that the objective of the STP is to find £1.3Bn of savings and that the template of the STP is set by the Dept of Health, it is impossible that the final numbers will be very different from the ones just published, using the same categories. SOH and its advisers have looked closely at all the pages in the workbook, including the "solutions" which are the balancing figures between the "Do Nothing" and the "Do Something" scenarios. Most of the solutions include words like "these costs have not been finalised". For Solution 4 (NHSE Specialised Commissioning) it says: "We have not yet developed the "solution" for closing the gap, however it is assumed that this gap will be closed. This is a placeholder".

The Delivery Plan is obviously nearly right too.

The denial by NW London CCGs is a clumsy attempt to limit the harm after the release of highly damaging information which should not have been disclosed on the grounds that its release would prejudice incomplete development of the plans. But then the FOI request would probably have been forwarded to the Information Commissioner and SOH would have made a big fuss about the refusal and about the fact that the figures were still being worked on three months after submission to NHSE on 21st October as a "final" version.

That is why the current dispute about the status of the information produced by the NHS's NW London Collaboration of Clinical Commissioning Groups reveals even more than the figures themselves

Brent Patient Voice have discussed the huge cuts in "Losing the power to shock".

Response by Dr Christopher Wood to article by Prof Chris Ham The King's Fund 12th Sept 2016

 

Christopher Wood

Consultant HIV Physician

North Middlesex University Hospital

19 Sep 2016

 

Professor Ham, thank you for your detailed, but much understated piece - notwithstanding the statement about STPs that..... 'they are attempting to undertake synchronised swimming against a rip tide'!

The reality is that the current plans and timescales being imposed on STPs are reckless and dangerous. There should be an IMMEDIATE MORATORIUM called on STPs and other similar major re-organisations of the NHS that are in the pipeline.

STPs may well be fine in theory - and that is debatable - but as you clearly state they are not a short-term answer to austerity and quickly delivered savings. In their current incarnation - with the expectation of immediate savings and transformation occurring in a fraction of a financial year they are a reckless and dangerous absurdity. The only sane solution is a moratorium. The NHS and its funding need a proper overall review with some bridging funding made available to meet the immediate needs of the NHS deficit and a proper cross-party/stakeholder consultation to decide its future.

The need for the Acute sector cannot be 'wished away' as you make clear in your piece. I suspect that a lot of recent health policy has been made by fantasists in denial that acute illness really exists. The acute sector has been mistakenly marginalized since - at least - the introduction of the fatal Lansley 'Health and Social Care Act' and the Darzi report.

It will take years of coordinated planning and investment to get prevention and social care to the point where they can make a real impact on hospital activity and the more acute and severe manifestations of ill-health. This certainly will not happen while the current mania for major uncoordinated and unfunded interventions is indulged by the detached and unaccountable elites currently making health policy.

The leadership and vision that the NHS needs is completely lacking from the Secretary of State for Health, the DoH and NHS England - otherwise why would any serious health policy makers be endorsing the unsightly haste with which STPs are being pushed forward? It is a dangerous collective delusion in the context of an engineered funding crisis, collapse of workforce morale, years of austerity cuts and an arrogant policy-making elite who have no interest or respect for 'evidence', 'piloting' or consultation. I have to try and hope that many of them are likely to be well meaning, but many others seem to have serious problems with the original 'mission' and aims of the NHS and are impatient and opportunist in their desire to re-fashion it into something that I believe the great majority of the population that the NHS serves would find very disturbing.

In summary, I believe that there needs to be an immediate moratorium on STPs and other major NHS re-organization, including the increasing role of the private sector. Bridging funds need to be made available to consolidate safe healthcare in the short-term while these issues are being sorted out to mitigate the impact of the current chaos.

The debate will need to start with a public debate about the amount spent on health in the UK as a proportion of GDP, in order to ensure that 'affordability' for the NHS is decided by the population at large with a clear view of the wider political and other factors and choices that help to define 'affordability' and the 'limited' funding for the NHS.

The King's Fund and the Nuffield Trust have already provided sufficient dispassionate and well-researched data and analysis to inform many of these issues and help start the process. However, unless the brakes are put on the current inchoate jumble of proposals and policies, the impact on the NHS and the nation's health will take years to unravel and will be the cause of much unnecessary human suffering.

Sincerely yours,

Dr Christopher Wood (with over 30 years service in the NHS, nearly 20 of those as a Hospital Consultant)

 

 

 

 

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