March 2017: Update on Councils opposing their STP

Calderdale and Kirklees 999 Call for the NHS article dated beginning March 2017


In early December 2016 Calderdale & Kirklees 999 Call for the NHS  posted a summary of 19 Councils’ negative responses to their “footprint” Sustainability and Transformation Plans after the Clinical Commissioning Groups  published them following submission to NHS England on October 21st.

Since then Calderdale & Kirklees 999 Call for the NHS has had news of 13 more Councils’ negative responses to their Sustainability and Transformation Plans – which Defend our NHS campaigners have variously dubbed Switch to Private, Slash Trash and Privatise, and Secret Theft Plans.

These Councils are:

  • Bristol City Council
  • Devon County Council
  • Isle of Wight Council
  • North Devon District Council
  • North Yorks County Council
  • Oxford County Council
  • Redcar and Cleveland
  • Sheffield City Council
  • Waltham Forest Borough Council
  • Warwickshire County Council
  • West Sussex County Council Health and Wellbeing Board
  • Wirral Council

More details below.

Bristol City Council

The full Council passed a Sustainability and Transformation Plan motion on 17th Jan 2017 that includes:

“Write to the relevant government Ministers to make them aware … of our opposition to their unreasonable funding cuts… Publicise likely impacts on key services and our opposition to these funding cuts to the people of Bristol and encourage them to make their views known and campaign against the national cuts to the NHS.”

Devon County Council

On 19 January 2017 the Devon County Council Health & Wellbeing Board Scrutiny Committee passed a resolution that

the decision to call for a ‘pause’ in the work of the Success Regime/Sustainability and Transformation Plan process taken by the County Council on an all-party basis be…noted and that the County Council continue to press for this to happen; that Devon MPs be lobbied to act upon the Notices of Motions passed by Devon County Council and urge them to tackle NHS England and Government to halt the Success Regime/STP process and press for fair funding for Devon.

At the December Devon County Council full meeting, Councillor Biederman MOVED and Councillor Wright SECONDED:

“This Council is deeply concerned about the impact the proposed cuts to Devon health services will have on patients – especially the loss of whole departments including maternity services at North Devon District Hospital – and massive reduction in acute and community hospital beds across Devon, as set out in the sustainable transformation plan.
This Council also recognises that Governments have deliberately not provided the NHS with the adequate level of funding and now calls on local MPs to lobby government ministers to urgently and significantly increase the level of funding to the NHS, in order to protect our precious health services for current and future generations”

Councillor Greenslade having MOVED and Councillor Biederman having SECONDED:

“County Council believes that the NHS Success Regime project for Devon is now seriously flawed and accordingly calls on the Secretary of State for Health and NHS England to cancel it forthwith. County Council further calls on Government and NHS England to firstly address the issue of fair funding for our area and to ensure the general election promise of an extra £8 billion of funding for the NHS is taken into account when assessing the claimed deficit for Devon NHS services”

Isle of Wight Council

The Hampshire and Isle of Wight (HIOW) Sustainability Transformation Plan (STP) was considered by the meeting of the Isle of Wight Council’s Executive on Thursday 13 October 2016, and at both the Scrutiny and Health/Social Care Scrutiny Sub-Committees (11th and 17th October 2016 respectively).

The Isle of Wight Council’s Executive Minutes record that:

At the meeting of the Executive, concerns were raised about the very tight, nationally imposed timescales involved and the potentially significant financial impact on Island residents that required access to mainland services. Whilst recognising the need to progress the plan, members agreed that there was not sufficient opportunity to give it detailed consideration and support before the required submission deadline. As a consequence, the Chief Executive was authorised, in conjunction with the Executive
members for Adult Social Care and Integration, Public Health and Children’s Services and the Chairman of the Health and Adult Social Care Scrutiny Sub Committee to consider and agree an appropriate response to the plan, on behalf of the council and for inclusion with the final submission to NHS England.

Following these meetings, the Council’s Chief Officer wrote to NHS England :

The Committees were disappointed, the timescales to produce the plan, dictated by NHS England, did not give sufficient weight to the democratic process allowing it the opportunity to consider the final plan, or debate the issues it raises in a public forum, and did not appear to conform to the best practice guidance (for example Engaging Local People -NHS September 2016).

North Devon District Council has agreed a motion to halt the STP.

North Yorks County Council

Daniel Harry, Scrutiny Team Leader, North Yorkshire County Council sent a letter to a member of public with this information:

“[T]he Council’s position with regard to STPs is that we continue to request that the Secretary of State and NHS England review the STP boundaries with a view to creating one STP for North Yorkshire. This position is supported locally by the North Yorkshire Local Medical Committee (which represents GPs in the county), City of York Council, East Riding Council and Hull City Council.
The Council has also adopted the position to note but not sign off the three STPs at this stage.”

Oxford County Council

Sustainability and Transformation Plan proposals to cut £200m from the NHS in Oxfordshire by 2020 have been criticised by Oxford County Council for lacking information.

County councillors said they are not satisfied with the proposed plan, which could see services moved from the Horton General Hospital in Banbury  to the John Radcliffe in Oxford.

Member in charge of public health, Hilary Hibbert-Biles, said the proposals were
“not coherent”.

Oxford Keep Our NHS Public reports that Oxfordshire County Council Cabinet are opposed but haven’t yet had the full council endorsement (21 March).

Redcar and Cleveland

Redcar and Cleveland Council passed a resolution at its Full Council meeting on February 16th 2017 which declared opposition to the local NHS “Sustainability and Transformation Plan” (STP) which covers Teesside, South Durham and a part of North Yorkshire and aims to cutting £281 million from the regional NHS budget.

The resolution’s mover, Councillor Ian Jeffrey said,

“across the country local NHS trusts and agencies are being ordered to draw up these plans, which, at heart, are exercises in reducing present overspends in hospitals and primary healthcare services. The local STP, contains proposals to close at least one major A and E unit on Teesside, perceived threats to maternity services and a reliance on so-called ‘self care” instead of using health centres or referrals for in-patient treatment in a local hospital.

I and my fellow Councillors believe that these plans are the precursors of a wider agenda to privatise and cut down on NHS services in an area which, due to gross health inequalities when compared to elsewhere in the country, are desperately needed.. Cuts are not the answer – more investment and longer term thinking is needed from this government. This resolution echoes similar calls by councils across the country – including big cities like Liverpool.”

Sheffield City Council

In December 2016, Cllr Cate McDonald, Sheffield city council’s Cabinet Member for Health and Social Care, on 7 December 2016, told Cllr Douglas Johnson,

“The Administration does not intend to approve the NHS’s local Sustainability and Transformation Plan.”

This was in response to a question from Cllr Douglas Johnson, a member of the council’s Health and Social Care Scrutiny Committee:

“When does the Administration intend to approve the NHS’s local Sustainability and Transformation Plan for a funding gap of £571 million across South Yorkshire and Bassetlaw?”

Cllr Douglas Johnson said:

“The STP process is very much a top-down reorganisation of the NHS.
“I felt that members of the Scrutiny Committee I sit on were being fobbed off without proper discussion of the plans…
“I therefore called for a further Scrutiny Committee to discuss the plans…
“I am therefore pleased that the Administration has made clear it will not be signing off the local STP.”

An examination of the South Yorkshire & Bassetlaw Sustainability and Transformation Plan by the Council’s Healthier Communities and Social Care Scrutiny Committee was scheduled for 4pm on February 8th.

Sheffield is part of the South Yorkshire and Bassetlaw area. £107m of the proposed £571m of cuts across South Yorkshire and Bassetlaw relate directly to local authority functions of social care and public health.

Even though Sheffield Council rejected the S.Yorks & Bassetlaw STP,  NHS England lists the Council as an “early adopter” of the Integrated Personal Commissioning Programme, which is included in the S. Yorks and Bassetlaw STP.

The Integrated Personal Commissioning Programme blurs the lines between universal publicly funded NHS and mostly privatised means-tested local authority social care for patients with “complex needs”. As such it is a back door route to NHS privatisation.

This is a key aspect of Sustainability and Transformation Plans – so it’s important to realise that Councils’ opposition to STPs may well be more apparent than real.

Waltham Forest Borough Council

NE London Save Our NHS posted in the facebook page on January 17,

Waltham Forest Borough Council Cabinet has today decided it cannot sign up to the NE London STP.  It voted unanimously not to endorse the STP in its current form. Cllr Angie Bean was very angry about the underfunding of social care and the NHS. The Council is taking a strong stance against the government’s underfunding of the NHS. Council leader Chris Robbins highlighted the gross injustice of social care funding. The Council welcomes campaigning with NE London Save Our NHS on this.

Cllr Ahsan Khan, cabinet member for health and wellbeing, recommended the cabinet should reject the Sustainability and Transformation Plan. He said:

“I am sure the council will all agree that we are in an NHS crisis.
“The plans are being rushed through with lack of consultation and democratic oversight.”

Warwickshire County Council

At a meeting on Tuesday, 13th December, the council said it would not support the Coventry & Warwickshire Sustainability & Transformation Plan (STP) until: the health and wellbeing boards of both Warwickshire and Coventry councils had had an input, it is rewritten in language which is accessible to the public, consideration is given to appointing an independent chair to see it through,  it takes into account the crucial role of social care, and it recognises local and easy access to services by the whole population as a fundamental principle.

West Sussex County Council Health and Wellbeing Board

This is a quote from the chair of West Sussex County Council HWB about the Sustainability and Transformation Plan (Footprint 33):

I do have to point out that the County Council will not be signing up to a memoranda of understanding as the document is very focussed on the roles of health partners and is not easily applicable to the County Council. WSCC continues to support the development of locality based plans that have a focus on prevention and support the Council’s key strategic drivers of giving children the ‘best start in life’ and enabling ‘independence in later life’.

Wirral Council

A full meeting of Wirral Borough Council passed a motion to reject the Cheshire & Merseyside STP.

The Council agreed to write to the Secretary of State for Health and call on the government to withdraw these Plans immediately with a view to holding urgent discussions with key partners, including local Councils, on how good quality health and social care services can be provided based on continuing to provide a National Health Service which is properly funded and free at the point of need.

The motion carried said:

“This Council is extremely concerned about the failure of NHS England to consult with elected members and the public prior to the publication of Sustainable Transformation Plans which propose far-reaching changes to the configuration of hospitals in the acute sector and the delivery of health services in Cheshire and Merseyside in order to plug a £908m hole in the NHS finances.

Council agrees to write to the Secretary of State for Health and call on the government to withdraw these Plans immediately with a view to holding urgent discussions with key partners, including local Councils, on how good quality health and social care services can be provided going forward based on continuing to provide a National Health Service which is properly funded and free at the point of need.

Council is appalled that under this Tory government we have:
·      The worst NHS deficits on record – £2.45 billion
·      In England around 3.9 million people are now on the waiting list to start treatment
·      1.8 million people waited four or more hours in A&E last year – up over 400 per cent since 2010
·      One in four patients have to wait a week or more to see or speak to a GP or nurse, or don’t get an appointment at all.

Council calls on Theresa May to give the NHS the funding it needs.”


Wake up to the Accountable Care Organisation threat!

Calderdale and Kirklees 999 Call for the NHS article of 1st March 2017


Simon Stevens, the NHS England Chief Executive,  just told the Public Accounts Committee that some Sustainability and Transformation Plans will soon get going as Accountable Care Organisations or systems.

This sounds like more tedious, senseless jargonising.

Indeed one MP, Anne Marie Morris, was so bemused by what Simon Stevens was saying, she asked if they were all smoking dope.

But behind the jargon smokescreen – whether wacky baccy or not - setting up Sustainability and Transformation Plans to run the NHS as Accountable Care Organisations opens up the NHS to privatisation on a bigger scale than anything seen so far.

And it is a mechanism for limiting the range of care that the NHS offers, and for denying care to patients who are judged to offer poor value for money.

This would mean the end of the NHS as a service that provides the full range of health care to anyone who has a clinical need for it.

How does this work?

Sustainability and Transformation Plans require the speedy dismantling of the NHS to turn it into a health service that is based on American private health insurance systems – such as United Health,  the former employer of Simon Stevens, now NHS England’s Chief Executive.


Sustainability and Transformation Plans copy United Health’s  “new models of care”, that are delivered through:

  • a “modern” – ie de-skilled and de-professionalised (cheaper) – workforce,
  • lots and lots of costly digital technology and
  • new types of contracting that involve setting a fixed per person budget for a population, instead of the current payment per treatment.

This bulk contracting with a fixed per person budget (aka capitated budget) restricts patients’ access to limited treatments that are specified as “managed care pathways.”

It also contains an incentive to limit care to patients who are cheapest to treat and offer the best return on investment.  Providers are allowed to keep any “profit” – and they carry the risk of overspending.

Responsibility for carrying the risk of overspending has already led to the collapse of one of the first NHS Accountable Care Organisations, the Torbay and South Devon Integrated Care Organisation – see below for more info.

These limitations on the types of care and restrictions on who gets care - aka “demand management” - will drive people who can afford it to go private.


Such bulk capitated contracts are also probably unlawful, under current NHS legislation.

That does not deter Simon Stevens, who on 27th February told the Public Accounts Committee:

“We will get probably between six and 10 of them [STPs] going as accountable care organisations or systems, which will for the first time since 1990 effectively end the purchaser-provider split, bringing about integrated funding and delivery for a given geographical population.  This is pretty big stuff, and people are pretty enthusiastic about it.”

The Public Accounts Committee were not so enthusiastic, since they’d just spent ages questioning Simon Stevens and other key NHS and social care bureaucrats about the National Audit Office report on the failure of integration of health and social care through the Better Care Fund.

MPs described the situation as chaotic.


Ending the purchaser/provider split locks in large-scale privatisation

Ending the purchaser/provider split in a marketised/privatising NHS is a sly way of locking in privatisation on a scale we’ve not seen before –  as planned by the previous NHS England boss David Nicholson and reported by Alex Nunns in 2013.

  • You start out with an integrated NHS that is one of the most efficient in the world.
  • Then you split the purchasers from the providers, as the Tory government did around 1990.
  • Then you privatise the providers. As the New Labour, Coalition and current Tory government have.
  • Then you privatise the purchasers. As the current Tory government has.
  • And then you set up ACOs (aka Integrated Care Organisations) to abolish the purchaser provider split!

Except that in the meantime you have successfully moved a public health service into the private sector. And in just four simple steps!


Hunt_ACOs_9 May2016 HoC Health Select Committee
What Jeremy Hunt told the Health Select Committee on 9th May 2016

The recent King’s Fund’s Sustainability and Transformation Plan Report claims that doing this would require legislative change, to remove the competition requirements of the 2012 HSCA.  Such legislative change would  lock in NHS privatisation.

The kind of legislative change the Kings Fund is talking about would be like the Efford Bill, which the Labour Party put forward as an alternative to the NHS Reinstatement Bill,  to take out the competition section of the HSCA.

The trouble with this is that once you remove competition from a marketised NHS, you allow private health companies to establish monopolies.

All the pieces for terminal NHS privatisation are being stealthily manoeuvred into place. And campaigners are being diverted from these machinations by a mega march calling for an end to NHS under-funding. Which wouldn’t solve these problems at all.

It would create a bigger income stream for profiteering private companies that are manoeuvring – with government support – to take over the NHS.

Pro-privatisation think tanks spread misinformation for governments

The promotion of Accountable Care Organisations that replicate US private health insurance models is based on “evidence” that comes from the pro-privatisation think thanks and management consultants that the Department of Health and NHS England have effectively outsourced policy making to. Their suggestions are built on sand.

George Monbiot’s analysis of the role of lobbyists and consultancy companies in spreading the misinformation ocean that Donald Trump floats in also applies to successive governments’ stealth plans to dismantle the NHS.

Existing Accountable Care Organisations go belly up

There’s no evidence that these footprint-wide Accountable Care Organisationss are going to work – the Torbay and South Devon Integrated Care Organisation has already gone belly up and so has the Northumbria Acountable Care Organisation, aka Northumbria Healthcare.

The poster child for NHS accountable care organisations, Northumbria Healthcare is intended to hold a single contract for acute, mental health and community services, and adult social care.

Due to go live on 1st April 2017, after operating in shadow form this financial year,  its launch has now been delayed indefinitely because Northumberland Clinical Commissioning Group – the primary commissioner for the Northumbria Accountable Care Organisation - is broke.

Northumberland Clinical Commissioning Group’s governing body papers said the Clinical Commissioning Group requires written confirmation from NHS England that its financial position will not impact on its ability to “become part of” the Clinical Commissioning Group, but the NHS England quango has not made a decision yet.

And NHS England has tried to get them to cover up their dire £41m projected deficit.

The Clinical Commissioning Group’s governing body papers from February show that while the Clinical Commissioning Group was officially forecasting a £5m deficit for 2016-17 up until December, it is now forecasting to end the year with a deficit of £41m.

Minutes of the audit committee included in the 15 February governing body meeting also suggest NHS England had asked the trust to not report the deterioration.

The report said:

“There was discussion regarding the continued formal reporting of a £5million deficit when the actual position is £41million.

“The CCG has repeatedly discussed the actual financial position with NHS England but has been asked to continue to report the deficit as £5million.”

South Devon and Torbay Integrated Care Organisation kicks the bucket

The Torbay and South Devon Integrated Care Organisation was set up in October 2015, following participation in the NHS Kaiser Beacon programme –  a pilot to introduce the system used by US private healthcare company Kaiser Permanente, with the aim of cutting costly hospital services and replacing them with a new, low-cost system of integrated health and social care in the community that’s intended to keep people out of hospital. It’s known as “demand management”.

The Integrated Care Organisation’s mission was to pool health and social care budgets and run the services from under one roof – effectively the MultiSpeciality Community Provider model that is a common feature of Sustainability and Transformation Plans.

But Torbay and South Devon NHS Foundation Trust has now told the two councils involved in the Integrated Care Organisation that it is withdrawing from a ‘risk-sharing’ agreement, which splits liabilities for unexpected costs.

Torbay Council papers indicate that the Integrated Care Organisation has overspent by £12m in its first year, sparking fears that the organisation presents a ‘substantial financial risk’ to the local authority.

With financial strife in the Integrated Care Organisation, councillors have called for ‘a different dialogue’ with the Government.

No evidence this model works

This is unlikely to be a one off – as a recent BMA article reiterates, there is no evidence that this model works.  Slaves to zombie policies should take note and stop cutting our hospital beds and trying to turn the NHS into a version of US Medicare complete with American health companies,  and take note of the BMA article that says:

“We have the evidence problem—there is very little of it to support the idea that providing alternative service delivery models will enable more bed closures. A series of systematic reviews carried out by the Universities of Bristol and Cardiff showed very inconsistent evidence of interventions intended to prevent unplanned adult admissions to hospital. And an equally thorough review of approaches by the Nuffield Trust—including case management, integrated community teams, virtual wards, or telecare—was unconvinced of the evidence base for these interventions reducing hospital activity or bed occupancy.”

The Prime Minister, Teresa May, has announced a review of policy on social care funding, delivery and integration with health, amid huge concern about failure in the sector.

Find out more:

Here is the Public Accounts Committee oral evidence 27 Feb 2017


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

Calderdale and Kirklees 999 Call for the NHS - article of 10th November 2016, updated on 9th March 2017 for the Budget announcements.


Far from the Sustainability and Transformation Plans marking the government’s shift away from NHS marketisation and privatisation – as some are mistakenly claiming – the opposite is true!

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

Update 9 March 2017

Behind the derisory £325m STP funding in Hammond’s Spring Budget (for a few “most advanced” STPs)  is the plan for 50% of STP funding to be sourced from private companies via Local Economic Partnerships by 2020 – please see section below: “Strategic partnerships with the NHS and the 39 Local Economic Partnerships”

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” – ie private companies – the aim is the “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 re-disorganisation “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 (Nov 2016) 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, mentioned in the previous section, 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 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 digital excellent 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 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.


Virgin Health suing NHS for contractual rights

Today's (13th March 2017) HSJ headline:

"Virgin Care starts legal proceedings against NHS: Virgin has launched legal proceedings against eight NHS commissioners after losing a bid for a £82m children’s community services contract"

As usual the details in the article are behind a paywall, but it is extremely likely that this story is about Bristol CCG's decision in 2015 not to award a contract for children's community health services to Virgin Health but instead to a community interest group. In February 2016 Bristol CCG deleted a rule in their constitution permitting them to not award to companies who avoided tax, after it was questioned during the tender process. Lawyers for the CCG reportedly feared that the rule discriminates against companies that are legally avoiding tax, thus allowing them to sue the NHS if they do not win the contract. There are a number of CCGs that have been forced to reconsider this type of clause in their constitution.

See The Independent article of 8th Feb 2016:

The difference between "legally" and "illegally" avoiding tax is a fine one and a paradise for lawyers.

To non-lawyers it is outrageous that the CCG is being restrained from insisting that the company awarded a contract behaves ethically. The NHS should be allowed to behave ethically -  it is THE public service with a conscience!

Such horrors will happen increasingly because the HSCA 2012 opened the awarding of service contracts to "any qualified provider". CCGs who attempt to keep their relationships with previous providers intact are in an increasingly perilous position.