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Issue: 68<\/b><\/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 Ealing Out Of Hospital (OOH) Services Outsourcing Contract: More Questions Than Answers<\/b><\/p>\n Rumour and speculation are rife about who might bid for and who might win this contract. The names of four London NHS Trusts have been mentioned. We are still no nearer discovering the real reason why this 10 year, \u00a3450 million minimum\/\u00a31.2 billion maximum, single supplier contract has even been proposed. The Invitation To Tender (ITT) was issued on 22 March 2018. \u00a0If awarded, this contract is likely to be the longest and potentially most lucrative NHS outsourcing contract ever awarded in England. It could make the local commissioner \u2013 the NHS Ealing Clinical Commissioning Group (ECCG) \u2013 quite famous.<\/span><\/p>\n <\/p>\n Quite simply, OOH services in Ealing might be described as some of the day care services currently provided inside Ealing Hospital, outside Ealing Hospital and not provided in GP surgeries. Virtually all the OOH social care services included in the initial 36 services\u2019 specification are outsourced to private operators by Ealing Council. \u00a0<\/span><\/p>\n <\/p>\n Is It to Reduce OOH Services Costs?<\/b><\/p>\n No – says ECCG. Cost saving would be accrued by reductions in Non-Elective Admissions (NELs) to hospitals says ECCG. NELs are mostly accident and emergency admissions. The NELs volumes have remained pretty much at the same level in Ealing and North West London (NWL) since we have been monitoring NELs starting in April 2013. It will take some special magic for the appointed single supplier of OOH services in Ealing to significantly reduce the Delayed Transfers of Care (DTOCs or \u2018bed blocking\u2019) predominantly caused by lack of social care capability or mental health beds<\/span><\/p>\n <\/p>\n Is It to Improve the Quantity and Quality of OOH Services?<\/b><\/p>\n No explicit claims have been made or evidence provided to support such improvement by ECCG, the NHS NWL Collaborations of CCGs, the NHS NW Sustainability and Transformation Partnership (STP) , NHS NWL \u2018Shaping a Healthier Future\u2019, NHS England or NHS Improvement.<\/span><\/p>\n <\/p>\n Why is it a 10 Year Contract<\/b>?<\/span><\/p>\n We can find no answer to this one.<\/span><\/p>\n <\/p>\n Is It to Cut Down ECCGs Workload?<\/b><\/p>\n If a single supplier is to manage and resource 36 (and maybe 60) OOH services in Ealing over a 10 year period it makes little sense that ECCG would be micro-managing service delivery (i.e. \u2018commissioning\u2019) as well. \u00a0<\/span><\/p>\n <\/p>\n Is It A Trojan Horse for a Pioneer Integrated Care System (ICS) in Ealing?<\/b><\/p>\n ECCG says it\u2019s not an ICS (ACO in \u2018old money\u2019), which implies the budget will not be set using a \u2018Whole Population\/Capitated Budget\u2019 and fixed price approach.<\/span><\/p>\n <\/p>\n Who Will be Writing the Responses to the ITT?<\/b><\/p>\n No doubt it will be management and healthcare consultants. More \u00a3millions of public money sacrificed on the altar of \u00a0marketisation.<\/span><\/p>\n <\/p>\n When Do Responses to the ITT Have To be Submitted?<\/b><\/p>\n Initially this was to be by 23 August 2018, with an earlier deadline of 19 July 2018 for submitting a completed \u2018Selection Questionnaire\u2019. However as the procurement documents were delayed till 4 May 2018, there is a \u2018revised procurement closure date and associated deadline for submission of tenders\u2019.<\/span><\/p>\n <\/p>\n Are There any Precedents of Any Similar NHS Outsourcing Contracts?<\/b><\/p>\n Ominously the answer is yes, in Cambridgeshire in 2015. A five year \u00a3800 million NHS outsourcing contract ended expensively after just 8 months of operation. The contract was for a single supplier to manage and deliver community healthcare services to adults and elderly people in Cambridgeshire from 2015 to 2019.The company running it, called UnitingCare, pulled out saying that the contract was not financially sustainable. Warning signs appeared early on in the performance of the contract. Uniting Care had boldly promised estimating savings of \u00a3178 million by 2020. However they requested \u00a0\u00a0\u00a334 million of extra funding from the local CCG – just four weeks into the contract going live.<\/span><\/p>\n <\/p>\n UnitingCare was a consortium of Cambridge and Peterborough NHS Foundation and Cambridge University Hospitals NHS Foundation Trust. The local CCG chose UnitedCare because it was the lowest bidder.Unsuccessful, more expensive bidders were Virgin Care and Care UK. Both the Government Committee of Public Accounts and the National Audit Office were severely critical of the lack of commercial skills exhibited by the commissioning NHS CCG.<\/span><\/p>\n <\/p>\n Are Integrated Care Systems a Bad Idea Poorly Implemented?<\/b><\/p>\n Integrated Care Systems (ICSs) appeared on our radars in January 2018. They were a new name for Accountable Care Systems (ACSs). The justification for the renaming was never explicit, but many of us assumed what was behind it was that Accountable Care sounded too \u2018American\u2019.<\/span><\/p>\n <\/p>\n In May 2018 NHS England announced four more ICSs to add to the existing 10. The timing of this was appalling. The highly rated Judicial Review on ACS\/ICS legitimacy by JR4NHS had just enjoyed its two days in the Royal Courts of Justice. The 12 week public consultation on ACS\/ICS promised by NHSE in February 2018 has still failed to materialise. The ACS\/ICS enabling Parliamentary legislation the Government planned for February 2018 also never happened. The four new ICSs are Gloucestershire, Suffolk and North East Essex, West, North and East Cumbria, and West Yorkshire and Harrogate.<\/span><\/p>\n <\/p>\n According to \u2018Heath Service Journal\u2019 none of the original 10 ICSs have reached an agreement with NHSE\/NHSI about finances. Technically the arguments are about \u2018Control Totals\u2019 which seem to be the financial targets to be attained by end of March 2019. The sticking point is apparently that \u2018organisations are unwilling to risk losing their sustainability funding if a neighboring Trust or CCG fails to meet its financial plan\u2019. Not much peer trust or respect at work then.<\/span><\/p>\n <\/p>\n None of these 14 ICSs are any more than talk and good intentions. There are, apparently, no signed ICS contracts. If any of them were \u2018real\u2019 then NHS Clinical Commissioning Groups would be winding up as they would have lost their commissioning roles for healthcare. Local Authorities would be re-structuring as they would have lost their social care commissioning roles.<\/span><\/p>\n <\/p>\n Only an idiot would argue against the principle of integrating healthcare services and social care services. But with the current organisational structures and with the proposed ICS structure, the component care bits just do not \u2018fit closely and seamlessly together\u2019. The size and content of any NHS patient database is very different from its Local Authority (LA) social care service user database. The NHS and LA payment protocols, financial regimes, management accountability, cultures, IT and even vocabularies are alien to each other. <\/span><\/p>\n <\/p>\n The vast majority of social care services are outsourced to the private sector and are means tested. NHS healthcare services are largely \u2018insourced\u2019 and are free at the point of use. Finally, NHS bodies and LAs don\u2019t seem to trust each other enough to open up their financial books to each other. What both healthcare services and social care services do have in common is that they are both under-funded and under-resourced.<\/span><\/p>\n <\/p>\n If \u00a0ICSs are implemented as advertised, this spells the end of the NHS. 44 private ICSs will run healthcare and social care services throughout England on fixed price, long term contracts. NHS Trusts, private care homes, private healthcare providers, NHS staff, NHS buildings etc will all be just resources which the ICSs may deploy or dispose of.<\/span><\/p>\n <\/p>\n The Mass Transfer of Property from Public to Private Ownership: The NHS \u2018Journey\u2019<\/b><\/p>\n Consider the following:<\/span><\/p>\n + University College London Hospital Foundation Trust recently boasted a \u00a376 million surplus after asset sales and a Sustainability and Transformation \u2018bonus\u2019. (\u2018Health Service Journal\u2019).<\/span><\/p>\n