<\/p>\n
Issue: 54<\/b><\/p>\n
1 November 2017<\/b><\/p>\n
<\/p>\n
This occasional newsletter is researched, written and edited by a group of concerned residents in Ealing, West London who want to preserve our NHS. We view the wholesale engagement of private, for-profit healthcare service suppliers as unnecessary, profligate and dangerous. Increased financial funding is what is needed in our NHS \u2013 not financial cuts, closure of vital services or privatisation.<\/span><\/p>\n <\/p>\n The Integration of Healthcare and Social Care is a Failure<\/b><\/p>\n Failed attempts to integrate healthcare services and social care services go back a long way. The National Health Service Act 1977 under Jim Callaghan\u2019s government encouraged Health Authorities and Local Authorities to co-operate. The Health Act 1999 allowed NHS bodies to pool budgets. Successive governments have again and again tried to pull NHS bodies and LAs closer together.<\/span><\/p>\n <\/p>\n However, it\u2019s been 40 years of failure.<\/span><\/p>\n <\/p>\n The House of Commons (HoC) has been busy recently churning out extremely helpful and informative impartial briefing papers on various aspect of care. I\u2019ve drawn heavily on one of these papers in this piece \u2013 \u2018Health and Social Care Integration: Number 7902, 20 October 2017\u2019.<\/span><\/p>\n <\/p>\n One assumes the goals of this integration would be better patient\/service user experiences, efficiency and cost cutting. The elephant in the room is that healthcare is funded and run by the Department of Health (DoH)\/NHS England (NHSE), and social care is funded by the Department for Communities and Local Government (DCLG) and run locally by Local Authorities (LAs).<\/span><\/p>\n <\/p>\n To continue the history lesson we had the Health and Social Care Act 2012 (\u2018..duty to encourage integrated working\u2019) and the Care Act 2014 (\u2018..promote the integration of healthcare provision\u2019). It\u2019s unclear as to how much integration these statutory \u2018encourage\u2019 and \u2018promote\u2019 initiatives actually achieved.<\/span><\/p>\n <\/p>\n The Better Care Fund (BCF)<\/b><\/p>\n The BCF was announced in 2013. It was to be the primary funding mechanism for integrating health and social care. A key goal was keeping older and disabled people out of hospital. \u00a3200 million was immediately handed to LAs. Spending the \u00a33.8 billion BCF should have achieved healthcare and social care integration by 2018 \u2013 but it won\u2019t have. In 2015 BCF was judged to be missing its bed reduction, elderly hospital discharge and independent living targets. Rather than saving on costs, costs rose by \u00a3200 million. An \u2018improved\u2019 version was introduced (iBCF). Another \u00a31.5 billion was thrown at it. In 2017 Local Authorities were granted \u00a32 billion for BCF 2017-2020.<\/span><\/p>\n <\/p>\n There has been much criticism of BCF. Apparently NHSE has effectively abandoned it. It seems the grant money wasn\u2019t \u2018new\u2019 money but \u2018old money\u2019 re-purposed. Informed observers found unrealistic levels of bureaucracy and expectations. Only 30% of the BCF money has been spent on social care. There are certainly patches of successful integration throughout England but neither DoH nor DCLG has tried to measure integration \u2018success\u2019 or estimate BCF cost savings. BCF was rendered largely redundant by NHS Sustainability and Transition Plans (STPs) published in October 2016. \u00a0<\/span><\/p>\n <\/p>\n Integrated Care Pioneers<\/b><\/p>\n Launched in 2014 in 14 local areas, and in an additional 11 in 2015, some piecemeal success has been achieved. However the Policy Innovation Research Unit noted difficulties in accessing external support, and problems with data sharing, payment systems, and procurement provider viability.<\/span><\/p>\n <\/p>\n Vanguards<\/b><\/p>\n 50 were established in 2015 \u2013 often involving NHS bodies and LAs. A National Audit Office report in 2017 highlighted some early integration successes but whether this success could be scaled up and sustained (post grant-aid), and deliver cost savings is debatable.<\/span><\/p>\n <\/p>\n Health and Wellbeing Boards (HWBs)<\/b><\/p>\n The Health and Social Care Act 2012 required upper-tier LAs to create these boards. The Act mandated HWBs with a duty to encourage integrated working. HWBs are required to produce a Joint Strategic Needs Assessment \u2013 which looks at current and future local and social care needs. The King\u2019s Fund in 2014 observed that many HWBs showed limited ambitions for integration.<\/span><\/p>\n <\/p>\n Devolution<\/b><\/p>\n The devolution of health and social care to Greater Manchester was announced in February 2015. Care integration is a major aim. Care budgets (\u00a36.2 billion) were pooled as from 1 April 2016. Although there are local integration successes no major integration \u2018successes\u2019 or cost savings have been publicised.<\/span><\/p>\n <\/p>\n In London, a somewhat less ambitious care \u2018collaboration\u2019 agreement was signed by 33 NHS CCGs, 33 LAs, Public Health England and NHS England. There are three pilot integration projects in north east London, Hackney and Lewisham. They began in April 2017 and apparently don\u2019t expect success until April 2019. Care integration across London is not a collaboration goal.<\/span><\/p>\n <\/p>\n In Cornwall (2015), Liverpool (2016) and Cambridgeshire and Peterborough (2016) moves towards devolved integrated care are underway.<\/span><\/p>\n <\/p>\n Sustainability and Transformation Plans (STPs)<\/b><\/p>\n STPs describe how a region will meet the needs of the NHSE Five Year Forward View (FYFV) objectives published in 2014. Implementing STPs must collectively cut annual healthcare costs by \u00a322 billion by 2021.The integration of healthcare and social care is one of the stated goals for all 44 STPs. However details on the social care side of the integration equation are thin on the ground in many STPs. Given that 43 of the 44 STPs are run by NHS executives this healthcare bias is perhaps understandable. The Local Government Association LGA) and the Public Accounts Committee (PAC) have both expressed concerns about STP care integration. The LGA\u2019s main concern is the lack of involvement by LAs in the creation of STPs, and how STPs will interact with LA Health and Wellbeing Boards\u2019 integration plans. The PAC sees the risk that integration will become sidelined in the pursuit of NHS financial sustainability.<\/span><\/p>\n <\/p>\n Mental Health<\/b><\/p>\n Sadly it\u2019s no surprise that the HoC briefing paper makes no mention of integrating mental health care services with mental health social care services. Ignoring mental health needs has been a national pastime for decades. The NHS and LA care resourcing crisis is probably most acute in mental health. <\/span><\/p>\n <\/p>\n Accountable Care Organisations (ACOs)<\/b><\/p>\n Although completely ignored by the House of Commons briefing, ACOs are clearly planned to be the implementation \u2018engines\u2019 for cost cutting and care services\u2019 integration. ACOs will have 10\/15 year, fixed price contracts to deliver specific services to specific populations. They will use capitated budgets i.e. a standard, fixed annual budget for each service user. Will these ACOs finally deliver care integration? The answer to that is that no-one knows. Many of the ACS contracts will be \u00a3multi-billion ones \u2013 and nowhere in the world have ACSs been even attempted on this scale.<\/span><\/p>\n <\/p>\n ACOs is a jargon littered arena. We have Accountable Care Systems (ACSs), Accountable Care Partnerships (ACPs), Multispeciality Community Providers (MCPs), Primary Acute Care Systems(PACS) and Accountable Care Models. The DoH is hoping to get Parliament to agree to new regulations in February 2018 which will allow ACOs, amongst other things, to commission integrated care services. Pioneer ACOs start date is 1 April 2018 \u2013 but the NHS rarely hits its target start dates. <\/span><\/p>\n <\/p>\n There is precious little evidence (or public confidence) that the STP\/ACO approach (by those who know about it and grasp the significance of it) will achieve successful healthcare and social care integration or in fact meet the cost savings targets by 2021 or at all.<\/span><\/p>\n <\/p>\n Disintegration<\/b><\/p>\n Whether healthcare services and social care services are integrated or kept as separate services, is a moot point if the human resources and facilities needed to deliver each of the services are inadequate. Consider: <\/span><\/p>\n <\/p>\n + The number of care\/nursing home beds is decreasing \u2013 because of rising costs and falling revenues<\/span><\/p>\n + The numbers of Acute hospital beds and hospital A&E units are decreasing \u2013 because of Government\/DoH\/NHSE policy<\/span><\/p>\n + There are significant shortages of trainee and trained doctors, nurses, mental health staff, social and healthcare support staff \u2013 because of cost cutting, the salary cap, bursary removal, student debt, medical schools\u2019 capacities, overwork and Brexit fears<\/span><\/p>\n + Much of the NHS estate is old, not fit for purpose and needs refurbishing\/replacing \u2013 however the DoH\/NHSE approach is to empty the buildings and sell off the land<\/span><\/p>\n + NHS staff and LA staff don\u2019t understand each other, don\u2019t trust each other and don\u2019t want to share data \u2013 according to NHSE Director Professor Keith Willett.<\/span><\/p>\n <\/p>\n Maybe the sensible approach would be to accept that 40 years of trying and failing to integrate is quite long enough as a learning exercise. What we need is both the healthcare service and the social care service to be adequately funded, resourced, equiped and \u2018housed\u2019 with clear handover interfaces between each other. <\/span><\/p>\n <\/p>\n Yet Another Revolution?<\/b><\/p>\n It would take a major revolution to scrap the NHS and Local Authority social care services and replace them with a new National Care Service (NCS) which would provide integrated healthcare services and social care services both free at the point of use. I don\u2019t think we have got to that point where yet another revolution looks like the best option.<\/span><\/p>\n <\/p>\n However, it maybe that we have already embarked on creating this new care body. As from 1 April 2018, in theory, England will start to be covered by ACOs which presumably will take over from CCGs and LAs in commissioning healthcare, social care (Public Health?) and the integration of the two. This will make NHS CCGs and LA social care commissioning organisations redundant. Now imagine a national organisation being created which would manage all these ACOs. An \u2018Accountable Care England\u2019 could be set up and would in effect be this new National Care Service, which would make NHS England and probably the NHS itself redundant. All this is speculation on my part as the \u2018cunning plan\u2019 no doubt hatched at the WEF in Davos in 2012 has not yet crept into the public domain.<\/span><\/p>\n <\/p>\n The DoH Wants Parliament to Give the Green Light to ACOs in February 2018 <\/b><\/p>\n Consultation is underway, initiated by the Department of Health (DoH), on getting Parliament to \u2018bless\u2019 Accountable Care Organisations (ACOs) in February 2018. ACOs will be the cost cutting engines used to implement England\u2019s 44 Sustainability and Transformation Plans (STPs) \u2013 and reduce annual NHS costs by 20%. (As detailed above there are plenty of flavours of ACOs being touted by the NHS around England).<\/span><\/p>\n <\/p>\n NHS patients, social care users or even Local Authorities are not explicity asked to comment. NHS professionals, GPs and GP Practice Mangers are, however, expected to comment by 3 November 2017. (Overworked GP staff must be over the moon about even more paperwork to deal with).<\/span><\/p>\n <\/p>\n Much of the 21 page \u2018Accountable Care Organisations\u2019 document relates to allowing GP surgery GMS and PMS contracts \u2018to be suspended\u2019 \u2013 this, apparently, will facilitate GPs being able to participate in a \u2018fully integrated ACO\u2019. It seems that ACOs will be able to dispense drugs and appliances. Clearly the intention is that ACOs will commission care services along with NHS England, Clinical Commissioning Groups and Local Authorities (or ultimately instead of perhaps?)<\/span><\/p>\n <\/p>\n In all the 21 pages no reference is made to the primary purpose of ACOs which, of course, is massive cost cutting. Tragic really.<\/span><\/p>\n <\/p>\n 999 Call for the NHS Takes On NHSE with a Judicial Review (JR) Claiming ACOs are Illegal <\/b><\/p>\n Health Services Journal (HSJ) has revealed that this JR is now underway. 999 claims that the August 2017 Accountable Care Organisation (ACO) contract introduced by NHS England is illegal. 999 claims the ACO contract breaches the Health & Social Care Act 2012 at sections 115 and 116. These sections relate to the price a commissioner pays for NHS services and regulations around the national tariff. The fixed population budget \u2013 or \u2018Capitated Budget\u2019 as American ACOs call it \u2013 does not link payment to the number of patients treated or to the complexity of the medical treatment provided \u2013 as required by the Act.<\/span><\/p>\n <\/p>\n 999 Call for the NHS is a grassroots campaigning network dedicated to restoring a publicly funded, run, managed and provided NHS (www.999callforNHS.org.uk)<\/span><\/p>\n <\/p>\n Demand For A&E Services FALLING Not Rising at Ealing Hospital and Northwick Park Hospitals and Waiting Times for the Chronically Ill and Seriously Injured is the WORST in England <\/b><\/p>\n Colin Standfield has been collecting and collating attendance figures at NHS NW London Hospitals for over four years. The NHS in recent years has made this task more difficult by moving from weekly figures to monthly figures, by lumping Urgent Centre Centre (Type 3) figures with Type 2 and (the most seriously ill and injured) Type 1 figures. Merging Ealing and Northwick Park Hospitals into one NHS Trust (money saving no doubt) has further complicated getting at the facts. Finally timely release of data re A&E attendances and admissions is not a current NHS NWL characteristic.<\/span><\/p>\n <\/p>\n Here is the damning data for Ealing and Northwick Hospitals combined:<\/span><\/p>\n <\/p>\n A&E Attendances: <\/span><\/p>\n <\/p>\n July 2017<\/b> Types1, 2, and 3 \u2013 <\/span>28,701<\/b><\/p>\n July 2016 <\/b>Types 1, 2 and 3 \u2013 <\/span>29, 034<\/b><\/p>\n <\/p>\n August 2017 <\/b>Types 1, 2 and 3 \u2013 <\/span>26,222<\/b><\/p>\n August 2016 <\/b>Types 1, 2 and 3 \u2013 <\/span>26,911<\/b><\/p>\n <\/p>\n With these figures just how can NHS NWL executives continue to use terms like \u2018unprecedented demand\u2019? Is it down to lack of basic arithmetic skills? Or is there another explanation?<\/span><\/p>\n <\/p>\n Is the London North West Healthcare NHS Trust (LNWHT) Financially Sustainable?<\/b><\/p>\n In the horror show of today\u2019s NHS in which every part of the organisation (sorry \u2013 business) must make a profit and no part can be a cost centre, LNWHT (Northwick Park and Ealing Hospitals) appears to have intractable financial problems. Colin Standfield (again) points out that the LNWHT 2015\/16 Annual Report stated \u2018\u2026the Trust does not have a financial plan which brings the Trust back into financial balance in the medium term\u2019. In the 2016\/17 LNWHT Annual Report, LNWHT is seeking a minimum of \u00a349.5 million \u2018additional support\u2019. It further states \u2018\u2026the existence of a material uncertainty which may cast doubt about the Trust\u2019s ability to continue as a going concern\u2019. Given there\u2019s no evidence that the \u00a349.5 million \u2018support\u2019 has been forthcoming, could LNWHT soon being going into \u2018intensive care\u2019 of some kind?<\/span><\/p>\n <\/p>\n Is The Government Review of the Mental Health Act 1983 Being Led by <\/b><\/p>\n the \u2018Right\u2019 Person<\/b><\/p>\n Over 65 disabled organisations, campaigners and mental health professionals have written to Prime Minister May complaining about the appointment of Profesor Sir Simon Wessely. <\/span><\/p>\n <\/p>\n Wikipedia details a whole host of reasons why the Professor should not have been chosen. These include claims that the Professor has stated that Myalgic Encephalomyelitis (ME) Syndrome was driven by \u2018false illness belief\u2019. His \u2018Exercise Therapy\u2019 has been shown to cause 50% of ME sufferers deterioration in function. He has also played an active role in devising the theories of \u2018malingering and illness deception\u2019 which underpins Work Capability Assessment (WCA). WCA has had a disastrous impact on the lives of disabled people.<\/span><\/p>\n <\/p>\n Possibly not then an inspired choice for this role. Based on my 20 years as a mental health carer, my choice would have been the appointment of an experienced and respected psychologist, rather than a controversial psychiatrist. Surely the future of mental illness treatment is more one of talking psychological therapies than drug based psychiatric approaches?<\/span><\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Issue: 54 1 November 2017 This occasional newsletter is researched, written and edited by a group of concerned residents in Ealing, West London who want to preserve our NHS. We view the wholesale engagement of private, for-profit healthcare service suppliers as unnecessary, profligate and dangerous. Increased financial funding is what is needed in […]<\/p>\n","protected":false},"author":2,"featured_media":1243,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[],"tags":[],"class_list":["post-1423","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png","uagb_featured_image_src":{"full":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",1024,512,false],"thumbnail":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2-150x150.png",150,150,true],"medium":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2-300x150.png",300,150,true],"medium_large":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2-768x384.png",640,320,true],"large":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2-1024x512.png",640,320,true],"1536x1536":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",1024,512,false],"2048x2048":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",1024,512,false],"td_0x420":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",840,420,false],"td_80x60":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",80,40,false],"td_100x75":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",100,50,false],"td_180x135":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",180,90,false],"td_238x178":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",238,119,false],"td_265x198":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",265,133,false],"td_300x160":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",300,150,false],"td_300x194":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",300,150,false],"td_300x350":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",300,150,false],"td_341x220":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",341,171,false],"td_341x400":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",341,171,false],"td_511x400":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",511,256,false],"td_537x360":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",537,269,false],"td_640x0":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",640,320,false],"td_640x350":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",640,320,false],"td_681x0":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",681,341,false],"td_681x400":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",681,341,false],"td_741x486":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",741,371,false],"td_1021x580":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",1021,511,false],"mailpoet_newsletter_max":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",1024,512,false]},"uagb_author_info":{"display_name":"Eric Leach","author_link":"https:\/\/ealingsaveournhs.org.uk\/?author=2"},"uagb_comment_info":0,"uagb_excerpt":" Issue: 54 1 November 2017 This occasional newsletter is researched, written and edited by a group of concerned residents in Ealing, West London who want to preserve our NHS. We view the wholesale engagement of private, for-profit healthcare service suppliers as unnecessary, profligate and dangerous. Increased financial funding is what is needed in…","jetpack-related-posts":[],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/posts\/1423","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1423"}],"version-history":[{"count":1,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/posts\/1423\/revisions"}],"predecessor-version":[{"id":1424,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/posts\/1423\/revisions\/1424"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/media\/1243"}],"wp:attachment":[{"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1423"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1423"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1423"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}