Stephen Hawking and leading doctors to take Jeremy Hunt to court over 'back-door privatisation' of NHS

Full judicial review granted to determine the lawfulness of the Secretary of State's proposals to introduce Accountable Care Organisations 

By Shehab Khan - The Independent - 29th January 2018 21.30

 

Professor Stephen Hawking has won permission to take Jeremy Hunt and NHS England to court over controversial proposals to restructure the health service, The Independent can reveal. 

Mr Hunt has tabled a plan which could allow commercial companies to run health and social services across a whole region in what critics have described as allowing back-door privatisation. 

Leading healthcare professionals and Professor Hawking have argued an act of parliament is required, allowing MPs and Lords to scrutinise the proposals, before the policy is implemented and any changes to regulations are made. 

 

Lawyers from the Department of Health and NHS England have rejected these claims but a court has now ruled that a full judicial review will be granted to determine the lawfulness of Mr Hunt’s proposals. 

The news comes as pressure mounts on Mr Hunt after he faced a barrage of criticism during a record winter crisis for the NHS. One in five NHS hospital trusts ran out of beds in the first weeks of winter and adult patients were put on children’s wards as trusts struggled for space. 

Under Mr Hunt’s plans the boundaries between different parts of the NHS that pay for and provide care, such as hospitals, GPs and clinical commissioning groups, would be dissolved. 

Responsibility for patients in these areas would be held by new healthcare overseers called Accountable Care Organisations (ACOs) which could lead to newly merged NHS super-organisations or a non-NHS body being awarded contracts to manage and provide entire packages of care. 

These ACOs in turn could choose to either subcontract the service or provide it themselves.  

Campaigners say this would allow ACOs to control the allocation of NHS money but their accountability for spending it and their obligations to the public would be under commercial contracts, not parliamentary statutes. 

The ruling is the latest instalment in an on-going feud between Professor Hawking and Mr Hunt, with the scientist previously accusing the Health Secretary of cherry picking and misrepresenting research. 

The Department of Health described campaigners’ criticisms about ACOs as “misleading” and “irresponsible scaremongering”. 

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Hunt's secret NHS plan opens the door to further privatisation

By Dr Graham Winyard - published by Politics.co.uk on 15th January 2018.  Dr Graham Winyard is a former medical director of the NHS and deputy chief medical officer.

Brexit's dominance of media coverage and parliamentary time is providing the perfect cover for controversial reform of the NHS by stealth. 

Jeremy Hunt and NHS England's latest big idea is Accountable Care Organisations (ACOs). These bodies would be allowed to make most decisions about how to allocate resources and design care for people in certain areas.

At the moment, that's done by public bodies whose governance is regulated by statute, set up by parliament after wide consultation and sometimes fierce debate. ACOs, by contrast, can be private and for-profit bodies. They are not mentioned in any current legislation and would have no statutory functions. They are not subject to the statutory duties imposed on other parts of the NHS.

Although NHS England plan to get several ACOs up and running this year, no detailed policy proposals have been presented to parliament or the public. Indeed, details are so sparse that the House of Commons library briefing is forced to use definitions provided by the King's Fund, a health think tank.

Hunt is planning to lay a raft of secondary legislation - which doesn't require a full parliamentary vote - in February, so that the first ones can be up and running by April 1st.

The ACOs are going to be given long-term commercial contracts of between ten and 15 years. We know these are difficult to get right and expensive to get out of. Think of Virgin and the East Coast Main Line or the private finance initiative, which has left the NHS paying hundreds of millions to offshore finance companies for hospitals that cannot now be afforded. Warnings about risks of PFI were once brushed aside as alarmist, often by the same people who now dismiss criticism of ACOs in similar terms.

I'm working with four colleagues to challenge these proposals through judicial review. Our case is not concerned with whether ACOs are a good or bad idea. That's for parliament and the public to decide, not the courts. Our case is that such a radical and significant change cannot lawfully be introduced and implemented without public consultation, parliamentary scrutiny and primary legislation. The case was filed on December 11th and clearly struck a chord with the public. They've provided £176,000 through crowd funding in over 6,000 donations.

We are also deeply concerned that by using contracts instead of statute to allow ACOs to operate, the government is exposing the NHS to major risks.

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Update on Charing Cross Hospital - Report from Imperial NHS Trust to the NWL JHOSC 23rd Jan 2018

 

On 23rd January 2018, the NW London Joint Health Oversight and Scrutiny Committee, chaired by Councillor Mel Collins of Hounslow, received the following report from Imperial College Healthcare NHS Trust as an update on Charing Cross Hospital for the JHOSC meeting.

It re-iterated many of the points made orally at an Open Evening at Charing Cross Hospital on 27th November 2017. It confirmed that Charing Cross is safe until at least 2021, and it is unlikely that any realistic NHS business plan can be formulated which includes its closure after 2021, according to current demand and foreseeable future projections for acute services.

I have selected the report from the papers, highlighted in red and changed to italics the most important paragraphs. Please forgive the double page numbering, which went wrong during my editing in Adobe Acrobat.

French hospital system in crisis: open letter signed by 1000 doctors and health professionals from France's top hospitals

This is a translation of an article in "Libération" published on Tuesday 16th January - "Hôpital - Mille signatures et une urgence" ("Hospital - one thousand signatures and one emergency"). The letter starts: "We, hospital doctors and health service managers...."

An appeal by Professors André Grimaldi and Jean-Paul Vernant and Dr Anne Gervais of the University Hospital Centre of Grenoble [one of the top ten hospitals in France] has been co-signed by over one thousand other hospital professionals throughout France, warning of crisis in the hospital system.

Further cuts of 1.6Bn Euros have been imposed on hospitals. Their budget for 2018 will only increase by 2% while their workload will increase by more than 4% (public hospitals spend 36% of all health-related expenditure). In order to balance the budget the tariffs in the list of "tariffs by activity" ("T2A") will be cut once again. In order to try to keep their accounts in balance hospitals are forced to increase their activity year on year while reducing the number of staff. Always "doing more with less" means worse working conditions leading to an exhausted and demoralised workforce and, in consequence, poorer quality care. As the minister of health conceded: "We have come to the end of this phase and this system. For example, with T2A the system was supposed to make public hospitals believe that they are [profit-making] enterprises".

The letter:

"We, hospital doctors and health service managers, putting aside political or union affiliations, support the aim of the minister for health to improve the relevance of care offered by reducing the unjustified diversity of medical practices, by reducing the number of prescriptions for unnecessary [diagnostic] investigations, by improving co-operation between social care and hospital care, by choosing ambulatory care wherever it does not compromise the overall quality of care and by building a truly local health service. From the hospital's point of view, this is only possible if five conditions are met:

Limiting the application of T2A [the tariff system] to standard, elective types of care;

Guaranteeing stable tariffs at a level which corresponds to the real costs of care;

Providing new ways of financing non-standard, emergency care, especially a complete episode of hospital care and, crucially, an annual allocation linked to activity in the hospital. This hospital-wide support would encourage professionals to organize more ambulatory care and develop aftercare by "telemedicine". An annual budget linked to activity would give doctors and paramedic teams some freedom of action while working with managers.

Maintaining in each unit a sufficient number of staff to guarantee safe and high quality care. Whenever it becomes necessary to reduce [rising] activity this should not entail an automatic suppression of posts.

Concentrating activity [on fewer hospitals] when this is relevant to the health needs of the regions concerned, while at the same time keeping the cohesion of the different medical specialties on different sites. François Hollande [past President of France] promised to abandon "T2A for every care". Emmanuel Macron [current President] has made the same promise. We MUST act now before it is too late!"

 

The first article:

This has never happened before. More than one thousand doctors and health service managers from all types of hospitals, local and University centres, all over France, have signed an appeal warning of the very serious situation in French hospitals, and taking aim at a system of finance, the "tarification by activity" ("T2A") in crisis and threatening the quality of care.

It is almost unprecedented for doctors and other medical personnel to rally to a single movement ["mobilisation"] with the same sense of urgency and fear, whereas under ordinary circumstances they are usually concerned with their own job and type of work. "2018 will be the year of danger and uncertainty" says an older union member. "The unions didn't start this, although they do fully support it". This letter, which is a petition, was drafted after the minister for health, Agnès Buzyn, gave an interview to Libération in December. She described without understatement the hospital crisis: " "We have come to the end of this phase and this system. With T2A the system was supposed to make public hospitals concentrate on profitable activities, believe that they are [profit-making] enterprises [...] We nearly made hospitals lose their compassion and sense of vocation by making teams believe that they should only do profitable business. Hospital teams were distressed by this sea change. And we have reached the logical end".

"Double speak"

Is T2A the mother of all evils? The hospital professionals have focused their anger on it. Invented more than 10 years ago, this system meant to finance hospitals according to their activities

 

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