Mental Health crisis – Coventry and Warwickshire Partnership Trust.

Mental health outpatients’ buildings sell-off.  Coventry and Warwickshire Partnership Trust is getting rid of the following buildings

Yew Tree House, Leamington (a staff base)

Ashton Lodge, Leamington (a staff base)

St Mary’s Lodge, Leamington (outpatient clinics)

Mental Health Response Centre, Warwick (outpatient clinics)

a) Our petition to Coventry and Warwickshire Partnership Trust to stop the sell off of mental health outpatients’ buildings in Leamington and Warwick gathered 700 signatures at the Leamington Peace Festival.

This shows the deep concern about mergers and cuts in this already underfunded and threatened area – despite government protestations that mental health is a priority.

We now have 1000 signatures on our paper petition.

We also have over 500 signatures on the online version of this petition.

Please now spread the online petition – so we can get up to 1000 signatures online as well.

Just forward the link to your friends and family.

b) At the same time, we have breaking news that the local mental health trust, Coventry and Warwickshire Partnership Trust, is among the ten worst mental trusts in England for out of area placements.

The Health Service Journal (19th June 2019) reports that ‘NHS England singles out failing mental health trusts’.

Ten mental health trusts have been singled out by NHS England for dragging down the national performance on mental health out of area placements, HSJ has learned.

In a letter to regional directors, NHS England’s national lead for mental health Claire Murdoch demanded action be taken and she warned future transformation funding would be denied if improvements weren’t delivered.

She told regional leads they must ”take urgent action” as the 10 trusts accounted ”for the majority of out of area placement activity” nationally.

She warned: ”I am not confident that we have sufficient grip on the handful of OAPS outliers across the country” and outlined plans for trusts to begin reporting on a monthly basis.

In her letter, dated 3 June, she told the regional directors their poor performance by the small number of providers was causing “considerable concern not only within NHS England and Improvement, but to ministers at the Department for Health and Social Care”.

She told the directors: “The associated financial cost is extensive and unjustified in systems where the broader pressures on mental health services are significant”, adding that the activity in the 10 top worst trusts was not only consistently high but rising ”and is now offsetting progress across the rest of the country.”

She said it was critical that action was taken in the next six months if the NHS was to hit its target to eliminate inappropriate out of area placements in two years’ time.

An analysis of NHS Digital statistics by the Royal College of Psychiatrists has revealed a spike in inappropriate out of area placements during the last quarter of 2018-19, with the number of placements in March hitting the highest levels since August 2017.

According to the data, Lancashire Care Foundation Trust and Devon Partnership Trust have the worst performance, accounting for just over 20 per cent of out of area bed days in March.

According to data for March 2019, the below trusts had the highest number of inappropriate OAP days in the month.























This data gives SWKONP further concerns about reports that acutely ill mental health patients from Warwick and Leamington who at present go to St. Michael’s Hospital, Warwick, will have to go to Coventry for inpatient care.

We understand that Coventry and Warwickshire Partnership Trust is moving all acute beds from St Michael’s Hospital, Warwick, to the Caludon Centre, University Hospital Coventry and Warwickshire. How can this ward closure possibly help the existing unacceptably high level of out-of-area placements for our local trust? How can friends and family support these patients? What are the mental health impacts?

We shall be demanding facts about these plans from the CE of the Trust, Simon Gilby. Please watch out for our campaigning!


NHS data is a public asset. Why does Matt Hancock want to give it away?

NHS data is a public asset. Why does Matt Hancock want to give it away?

Relying on private tech firms to innovate is a mistake – and the dependencies it creates are a key part of the NHS privatisation process.

Open Democracy Rosie Collington 

This week, Health Secretary Matt Hancock launched a report with the Taxpayers’ Alliance (TPA), calling for increased automation of NHS services through partnerships with private sector technology companies. The pairing is highly questionable in itself – the (misnamed) Taxpayers’ Alliance is a right-wing lobby group backed by big business, which seeks to drastically reduce the role of the state and has previously called forreplacing the NHS with an “insurance-based model” of healthcare.

But that’s not all that should concern us. The report is just the latest in a string of moves by the Health Secretary to open up hugely valuable, publicly-held NHS datasets to the private sector. Vast amounts of private NHS data have been transferred to private firms, under the auspices of recent public-private partnerships to develop artificial intelligence and other data-driven technologies for the NHS. Some of them are highlighted in the TPA report itself. One such example is the partnership between the Royal Free NHS Trust in London and DeepMind, a wholly-owned subsidiary of Google’s parent company Alphabet. Announced in 2016, the agreement provided DeepMind with access to 1.6 million patients’ medical records, which it would use to develop and launch its new healthcare app, Streams. Although the way DeepMind handles NHS data has changed since the Information Commissioner’s Office deemed the agreement to have breached the Data Protection Act, the company has continued to develop and scale the app at further NHS Trusts across the country.

Big promises…

In the case of DeepMind, the company has stated that the app could help save lives lost each year by enabling doctors to identify life-threatening illnesses like sepsis more quickly. These sorts of big claims made at a relatively early stage in product development are fairly common in the private medtech sector, partly due to its reliance on venture capital and the associated demands for promises of high returns on investment.

While occasionally these technologies do yield good results in the end, the sector has largely not been held to the same regulatory or clinical standards that we have for the biopharma or biotech industry, for example. There have been damaging consequences for individuals, investors, and public infrastructure, several of which emerged last year. Users of the app Natural Cycles were misled by adverts claiming it was a “highly accurate” method of birth control, the Advertising Standards Agency ruled. The founder of Silicon Valley-based bloodtesting technology company Theranos was charged with criminal fraud for making false claims about the technology’s effectiveness. And a public-private partnership between a Danish public healthcare provider and IBM folded at the end of last year, with a former official involved in the negotiation saying: “It was very oversold, what IBM Watson could do. There is something of the emperor’s new clothes about it.”

It’s a complaint echoed by Martin Kohn, IBM Research’s former chief medical scientist, quoted in a recent article in engineering magazine IEEE entitled “How IBM Watson overpromised and underdelivered on AI health care”. “Merely proving that you have powerful technology is not sufficient,” Kohn commented. “Prove to me that it will actually do something useful—that it will make my life better, and my patients’ lives better.” In terms of peer-reviewed papers in the medical journals demonstrating the benefits of AI to patient outcomes and public health systems, Kohn added “to date there’s very little in the way of such publications, and none of consequence for Watson.”

The political economy of privatisation

The idea that the merely rolling out new technologies in the NHS will save public money is misguided. In fact, a key driver of healthcare cost growth in publicly-funded health systems is the procurement of new technologies. This is partly because they require new or adapted skills from the healthcare workforce, partly because so many of them fail to ever improve

patient outcomes.

It’s just one of a number of misguided ideas at the heart of the market approach that has dominated health policy for decades. An approach that sees patients as primarily economic units to be managed more “efficiently”, that sees privatisation and outsourcing as the solutions, and that wrongly assumes it’s the private sector that generates innovation. This political economy of healthcare is crucial for understanding public-private partnerships that involve the transfer of publicly-held datasets to private hands.

Creating public value

Perhaps most damningly, the public sector has not even succeeded in recouping a fair share of the immediate financial value of the data that is being used to develop new healthcare technologies. Providing access to data is seen as a secondary element of such partnerships, rather than recognised as what enables private profit and company growth. There is no doubt that this access is contributing to the bloated capitalisations of the companies producing the technologies and the bank balances of their investors. Google’s parent company Alphabet earned $39.27bn in revenue in the final quarter of 2018 alone.

The data held by public sector bodies is so valuable because it is unlike anything the private sector can collect by itself. Patient data held within NHS trusts and other public bodies may be decentralised and messy in parts, but it is often far more structured and comprehensive than health data the private sector can collect by itself. The failure of Google Flu Trends proves just how difficult it is to make worthwhile use of the unstructured, non-probabilistic big data captured by digital platforms. Ultimately, we have to assume that if Google could develop these technologies without accessing NHS data through a public-private partnership, it would. Google markets many other services and products to public sector organisations around the world.

Beyond its transaction value, a further risk of assuming the private sector will develop groundbreaking innovations in healthcare is that public sector research and development will remain underfunded, despite evidence that this is where many of the lifesaving technologies that we take for granted today were first developed. Research has also shownthat far from driving innovation in healthcare, the majority of new medicines patented by the pharmaceutical industry in recent years in fact offer little therapeutic advantage over existing treatments.

New asymmetries and dependencies

Perhaps the most significant danger of not only providing private actors like Google with access to these valuable datasets, but also investing in them to develop new technologies instead of our existing public sector research institutions, is that we are creating today new institutional dependencies on these companies to deliver services in the future. Once the partnership with a technology company ends, and its technologies have become established infrastructure or tools in the NHS, what political leverage will we have to negotiate new agreements that are beneficial to the public purse?

Ultimately, by relying on these unaccountable, shareholder-driven private actors to develop these technologies, deliver innovation and thus also build new knowledge bases and expertise, we are fostering new knowledge asymmetries. Public-private partnerships that involve big data transfer will not only weaken the power of the public sector in the future, but also potentially risk more instances where public actors are simply unable to assess the claims made by tech companies about what their products can do.

Looking forward?

We should be optimistic about the potential for new technologies driven by big data to enable us to live happier, healthier and more equitable lives. But the advent of artificial intelligence is no panacea. And we should also be concerned about how private tech companies business models often rely on the exploitation of so many workers, including at the level of the extraction of raw materials relied on to build them.

Once we understand how valuable NHS and other publicly-held datasets are, we can only see them for what they are: public assets. And like all public assets – whether council housing or hospitals – the use and misuse of our data deserves scrutiny. In the short-term, we need our politicians to put a stop to Matt Hancock’s ambitions to open up our healthcare data to private interests and see it for what it really is: the latest stage in the privatisation of the NHS. If we want to ensure the rewards of innovation are not only properly assessed but also accessible to everyone, we must likewise strengthen the knowledge and innovation base of the public sector through investing in its research institutions and universities.

Which brings us to the issue at the heart of all of this: that the only real way we can capture the opportunities these new technologies present is by truly democratising their development. That doesn’t mean we never work with the private sector, though it does mean rethinking what the private sector should look like in a democracy, what kind of ownership models work for all of us, and how our accountable public sector can drive this change. Above all, it means bringing discussions about value in healthcare – and elsewhere in society – back into politics.

WARWICKSHIRE HEALTH AND WELLBEING BOARD Date: 1 May 2019 Integrated Care System Update Following the publication of the NHS Long Term Plan


From: Rachael Danter, System Transformation Director Title: Better Health, Better Care, Better Value Programme Update 03 Better Health, Better Care, Better Value

1 1 Purpose The purpose of this report is to provide the Warwickshire Health and Wellbeing Board with an update on the Better Health, Better Care, Better Value programme and work streams, highlighting any key points as necessary.

2 Recommendations The board is asked to note this report and its contents

3 Background 3.1 Integrated Care System Update Following the publication of the NHS Long Term along with a 5 year investment schedule to support delivery work is underway to respond to this. Systems are asked to develop a 5 year plan (5 year refresh) which should highlight what activities will be delivered over the next 5 years in what timescales, in order to meet the LTP requirements.

This plan will need to be underpinned by a 5-year system-wide financial strategy and a capacity and resource plan. This 5 year Plan will be a refresh of the previous BHBCBV plan and provides us with an opportunity to identify what part that the BHBCBV programme will play over the next five years in supporting successful delivery of ‘the Vision for Population Health’ as well as detailing how the Coventry and Warwickshire NHS system, working with partner organisations will deliver the NHS LTP requirements.

The Transformation Plan will need to describe how and what we will deliver over the next 5 years. It will also need to show where investment will be placed and the impact of that investment in terms of improved outcomes and increased capacity and performance. Recognising our financial position, a significant part of the Plan will need to articulate how we will take costs out of our system.

Finally, the Plan needs to be developed and owned by our system leaders, our clinicians, our staff, our partners and our patients and the public. The Plan will need to identify all the activities that will be undertaken at Place, System and Network in order to maximise our opportunities as a system.

It will need to highlight how we will deliver our Constitutional targets and the milestones identified in the LTP as well as a number of system-wide transformation programmes. There are currently a number of key work-streams within our architecture that will need to work with the wider system to identify opportunities and reflect these in their individual work-stream plans. These work-streams are identified below:

03 Better Health, Better Care, Better Value

These work-streams have already identified their plan for 2019/20, which represents the first year of the 5 year Plan. Once the work-streams have identified the activities that need to be undertaken over the remaining four years the plans will be updated and the system then needs to map the activities into system and Place to be clear where the activities will occur.

Underpinning the Transformation Strategy needs to be a Financial Recovery plan which identifies where new investment will be placed but also where costs will be removed from the system to allow us to move towards a financially sustainable position. 3.2 Place Based Planning – 2019/2020 The NHS Long Term Plan (LTP) describes 2019/20 as a transition year for the NHS as we move from our traditional, competitive ways of working towards a more collaborative and integrated approach.

During this period, the Coventry and Warwickshire health and social care system, will focus on three key priorities; continue to deliver great care for our patients; to develop, test and embed the building blocks which allow us to transform the way we commission and provide services in the future; and to refresh our system Health and Well Being Strategy and develop an associated five year Transformational Delivery Plan that ensures we deliver the best quality and outcomes for our population, within the resources available.

The priorities are outlined below. 3.2.1 Priority One Throughout 2019/20, the BHBCBV programme will maintain over-arching responsibility for driving system-wide achievement of all national deliverables including the NHS Constitutional Standards and the targets/milestones identified in the LTP.

Each programme workstream has already identified the national deliverables for 2019/20 underpinned by a project plan. Where appropriate, these plans are mirrored at organisation and Place level to ensure system alignment. Cancer Maternity and Paediatrics Mental Health and LD Urgent and Emergency Primary & Community Transformational Assurance Statements Workforce Digital Estates Waste Reduction Population Health Management Proactive and Elective (inc. MSK) Stroke Frailty Pharmacy ICS Development Aligned Incentive Contract

03 Better Health, Better Care, Better Value.

Priority Two Significant transformational change is expected over the next five years. As such, in 2019/20 we will have all the necessary foundations in place to commence this transformational change at three levels; System, Place and Network. At system level, the BHBCBV programme will be redesigned to better support system-wide transformational projects and performance such as our ‘single shared-care’ record project, system-wide estates and digital strategies and a system-wide performance framework.

Priority Three In response to the NHS LTP we will take the opportunity throughout the spring and summer of 2019/20 to work with our Health and Well Being Boards, our Local Authority colleagues, other partners, our staff and the patients and populations of Coventry and Warwickshire to refresh our system-wide Health and Well Being Strategy. This will be underpinned by a revised system Transformation Delivery Plan that outlines the programmes of work we will undertake over the next five years to deliver the best quality and outcomes for our patients and population within the resources available. 3.4 Clinical Strategy – Update on identified priorities The clinical strategy sets out the current issues being faced across Coventry and Warwickshire’s health and care system and identifies priority areas where services could be improved and transformed to deliver better outcomes for local people. Following on from the last update around the key priorities, please see an update below.

3.4.1 Frailty The overall aim is to support every individual to stay as independent as they can for as long as possible by supporting them to increase their resources/ resilience and ability to bounce back from setbacks. The Initial focus on areas where there may be low value interventions: • Care Homes • Polypharmacy • Acute front door • Procedures in last year of life • Falls Some areas may require pump priming investment to enable change but should release resource/ or minimise growth over the short to medium term. This will allow investment in other areas where we think there is currently unmet need. Objectives, criteria and standards for each area are being developed with different members of the group supporting each area of focus.

3.4.2 Mental Health and Emotional Wellbeing The key focus of this group is to reduce MH in-patient demand to reduce related out of area placements (Low value intervention). Next steps include: • Producing logic models of several developing schemes (PCDU, HIU, Suicide Prevention HIU, physical checks for SMI, Street Triage, Safe Havens) to understand their potential impact and timescales • Qualitative review of case notes of people admitted to MH in-patient unit to understand pathway, opportunities for intervention and whether proposed interventions could have made a difference.

3.4.3 Musculoskeletal (MSK) The overarching aim is to de-medicalisation of the MSK pathways. The short-term objectives include: • Understand the current MSK pathways in each place, the plans that have been developed and the progress with these plans. • Challenge to what extent these plans align with best practice pathways and will release the indicative opportunities (RightCare and Model Hospital) • Release resources for investment in other programmes where there is unmet and/or growing need.

3.5 Transformational Programmes of Work 3.5.1 Proactive and Preventative The P&P workstream is focused on creating the system conditions for an uplift in prevention across health and social care. Standards and KPIs related to prevention form part of the business as usual of the Public Health team but are not overseen by this workstream. The P&P Executive met on 21 March to approve the future role, purpose and governance of the workstream, with a proposed refocusing in the context of the NHS Long Term Plan and refresh of the STP plan to include additional work themes that align with the development of a ‘Vision for Population Health Management. This will include consideration of how work to embed prevention across other STP workstreams could be further progressed. In the meantime, performance against the current Programme Mandate is strong. The Place Forum met on 6 March – it has now agreed an outcomes framework to enable oversight of direction of travel against the agreed system outcomes (Concordat) and is overseeing the delivery of the Year of Wellbeing 2019 which is galvanising energy and resources to upscale prevention across the system. The P&P workstream has a key role in providing intelligence to other workstreams through place-based JSNAs to ensure all workstreams are informed about health and care needs and assets at a local level. These are well underway in Warwickshire, with wave one (6 areas) completed, wave 2 under way (another 6 areas) and a further 8 by April 2020. Results are being widely 03 Better Health, Better Care, Better Value Page 5 of 10 shared, so commissioners can use them in their plan. In Coventry engagement activity on the pilot JSNAs has completed and a first citywide assessment will be reported to Health and Wellbeing Board on 8 April, to inform the refreshed Health and Wellbeing Strategy, and 2 initial place-based assessments are being finalised.

3.5.2 Maternity and Paediatrics Work is progressing well in Maternity to deliver the recommendations of Better Births. All assurance checkpoints with NHSE have been met. The Maternity Voice Partnerships (MVP) model has been agreed and recruitment to the paid chair role was undertaken on 19th March 2019. The post was successfully appointed, and the SRO will work with the incoming chair to develop a final work programme for the MVP. This will be signed off by LMS Board in May 2019. A detailed financial plan has been requested by the regional NHS E team, this is in development by senior finance leads and Heads of Midwifery, with support from the PMO. The aim is to submit this ahead of the next local NHS England deep dive in May 2019. The Paediatrics and Neonatal Clinical Steering Group (PCSG) are developing a paper for the provider alliance outlining pre-modelling work that has been undertaken by the relevant clinical and managerial leads. This paper will be received by the Provider Alliance Group (PAG) in April 2019.

3.5.3 Mental Health and Emotional Wellbeing Training sessions for GPs continue to take place to improve the dementia diagnosis rate in Coventry and Warwickshire. Feedback continues to be positive. The 6-month pilot of the Psychiatric Decision Unit went live on 11th February with all 6 of the proposed chairs now operational. This model aims to divert mental health patients away from the Emergency Department whilst they are being assessed so should start to help to improve flow in the acute trusts.

3.5.4 Planned Care The Better Health, Better Care, Better Value partners have continued to align work to both the national and local objectives. The STP is making good progress against all seven of NHS England’s national milestones. The First Contact Practitioner went live week commencing 25th February with a pilot in place in Stratford, initially for 2 sessions per week with a plan to increase as patient demand across Network increases. The system wide capacity and demand model was approved at the STP Board for implementation for Trauma and Orthopedics, mobilisation plans will now be developed. Strategic commissioners are looking to collect opinions from a range of people including staff, patients and other stakeholders around their experiences of Planned Care and 03 Better Health, Better Care, Better Value Page 6 of 10 about what good care looks like. The feedback from this engagement will be used to develop a set of “desirable criteria” and a draft outcomes framework for planned care.

3.5.6 Productivity and Efficiency Work is underway to procure and embed a shared finance system across the four NHS Trusts in Coventry and Warwickshire. The ambition is to have a system-wide finance solution hosted by one lead provider. Work continues to develop the programme plan to implement the system. Upgrade and migration to Integra 2 is underway at UHCW, WVT and CWPT. Implementation plans for SWFT and GEH, who are not currently on any version of Integra, are being developed. It is currently anticipated that SWFT and GEH will not go live on Integra until March 2020. Successful deployment and implementation of the same finance system across the health economy will improve effectiveness and efficiency in procurement, payment and debt recovery processes, as well as improve financial control. This has the potential to reduce the cost of back office functions through consolidating functions, standardisation and adopting best practice. 3.5.7 Urgent and Emergency Care Demand and Capacity System All three acute providers now have real-time UEC capacity and demand systems in place and as such the work-stream will be on target to deliver the national requirement. 3.6 Enabling Programmes of Work

3.6.1 Estates and Digital Health As we move towards the spring-summer planning for the five-year refresh, these two Workstreams will become integral to the development and implementation of our 5-year plan. Over the coming weeks, the Estates and Digital Health workstreams will be working with the clinical workstreams to identify their estates and digital health requirements and priorities. Following this, there will be the distilling of this information to support the development of a joined-up strategy for Digital Health and Estates to address the enabling priorities of the workstreams and secure future capital funding. This work will feed into the refresh of the 5-year plan.

3.6.2 Workforce A refresh of the infrastructure to support the workforce transformation agenda and the delivery of the workforce priorities has been undertaken. This has involved reviewing the membership of the Local Workforce Action Board and putting in place the underpinning 03 Better Health, Better Care, Better Value Page 7 of 10 sub-groups that will drive forward the priorities. These subgroups are: • Workforce planning; • Recruitment and Retention • Leadership and Organisational Development • Education and Development (a group that spans Coventry and Warwickshire and Herefordshire & Worcestershire) The following priorities have been identified for 2019/20: • Recruitment & Retention • Developing & embedding ‘new roles’ • Skills development for the existing workforce • Development of career pathways Investment plan for workforce development priorities for 2019-2020 will be considered at the next LWAB meeting in April

3.7 Related Programmes of Work 3.7.1 Cancer NHS Long Term Plan and priorities for Cancer Alliances Published in January 2019, the NHS Long Term Plan outlines several commitments to building and developing work already underway because of the Cancer Taskforce recommendations, including the programmes being delivered by the Cancer Alliances. The key priorities are: • Diagnose 75% of cancers at stage 1 or 2 by 2028, including lowering the age for bowel screening, rolling out HPV primary screening and extending lung health checks. • Roll out new Rapid Diagnostic Centres across the country so patients displaying symptoms of cancer can be assessed and diagnosed in as little as a day. • Introduce a new, faster diagnosis standard which will ensure that patients receive a definitive diagnosis or ruling out of cancer within 28 days. • Deliver personalised cancer care for all, giving patients more say over the care they receive. • Secure our place at the cutting edge of research, offering genomic testing to all cancer patients who would benefit, and speeding up the adoption of new, effective tests and treatments. There is an acknowledgement that as the LTP is implemented; Cancer Alliances will continue to be the driving force for change locally, building on the extensive transformation work already underway across the country. The 2019/2020 Planning Guidance re-affirms the central role of Cancer Alliances as system leaders, working with 03 Better Health, Better Care, Better Value Page 8 of 10 and on behalf of their Sustainability and Transformation Partnerships and Integrated Care Systems.

3.7.2 Cancer: Transformation programmes update Transformation funding for 2018/2019 of £8.8m capital and £6.5m revenue has been secured and in September 2018, the national cancer team advised that the Alliance would receive an additional £2.04m. The latter will be targeted at improving urological pathways. In November 2018 WMCA requested some changes be made with regards to funding to allow for the next steps of the digital pathology project to be delivered. This has been agreed. Allocation of funding in Phase 1 has now been distributed via a series of Accountability Frameworks developed with STPs outlining the specific transformation priorities and objectives to be achieved by each of the six STPs in the Alliance’s region. The Alliance is required to report quarterly on progress against delivery plans linked to NHS England Planning Guidance 2018/2019. Reporting includes financial plans; actuals; forecast outturn; risks and mitigations. To assist with reporting requirements, transformation funded posts are being advertised within STPs and delivery managers are being appointed to work for the West Midlands Combined Authority(WMCA).

3.7.3 Living with and beyond cancer (LWBC) The 2018/2019 planning guidance requires clinically agreed protocols for stratifying breast cancer patients from 1 April 2019. In December 2018 the Board agreed the WMCA personalised follow-up model for breast cancer. STPs are required to develop mechanisms to record and report on progress towards implementation, including detailed data on the specific elements of the Recovery package. Post treatment, patients will move to a follow-up pathway that suits their needs and ensures they can get rapid access to clinical support where they are worried that their cancer may have recurred. This approach will be followed for colorectal cancers in 2020 and other cancers by 2023. So long as it is robust and ensures that no patient is ‘lost to follow-up’, remote monitoring can be paper based. The Alliance is currently reviewing the available technical solutions for remote monitoring and will be holding an event in late February 2019 to explore a region-wide solution with industry partners, Somerset and Infoflex. A lead for LWBC from each STP will be appointed and they will form a steering group to deliver this programme across the Alliance footprint. STP digital roadmaps should include LWBC remote monitoring implementation plans.

03 Better Health, Better Care, Better Value Page 9 of 10 3.8 Stroke – Progress and current status of the pre-consultation business case • Over 200 people were invited to participate in a non-financial option appraisal for the location of stroke rehabilitation beds. These beds would be required by the small percentage of people who were not able to receive their rehabilitation at home. Over 40 people attended the event held on 5 November, and participants included representatives of the public, patients and professionals. • On conclusion of this event, the workforce planning was completed, and we are currently awaiting advice from the expert stroke clinical network as to the adequacy of the proposed rehabilitation workforce. • Once we have confirmed the workforce, the final costings of proposals can be concluded, and the financial option appraisal completed. The pre-consultation case will then be presented for signing off with the health commissioners and Better Health Better Care Better Value Board, as ready for presentation to NHSE for assurance testing. At this stage we will know whether the case is suitable for public consultation. A timeline of key events is shown below. • Further work has been concluded on ensuring that at times of peak and surge demand, the hospital services can accommodate the additional stroke patients ensuring adequate access to diagnostic and specialist bedded services. • The Integrated Impact Assessment of the proposals has been updated following the nonfinancial option appraisal. The detailed report and a summary are shortly to be made available as evidence of our consideration of assessment of the equality, travel, and health impacts of proposals prior to any decision to go to pubic consultation. • Each NHS provider trust, is being asked to sign off the final proposals as deliverable and sustainable, prior to the final pre-consultation business case being tested for assurance by NHS England. As NHS organisations are currently going through the final phases of contracting and operational planning for 2019/20, and NHSE and NHS Improvement are reforming under the leadership of Simon Stevens as the new single Chief Executive, it is not possible to forecast with certainty a timescale for the NHSE assurance review.

03 Better Health, Better Care, Better Value Page 10 of 10

Report Author(s): Lorraine Laing Name and Job Title: Head of STP PMO On behalf of: Better Health, Better Care, Better Value Board Telephone and E-mail Contact: Enquiries should be directed to the above person.

Virgin Care has pulled out of a controversial contract with a financially-challenged clinical commissioning group in the West Midlands, HSJ has learned.

Health Service Journal ​30th April 2019

Virgin Care pulls out of controversial community services contract in
East Staffordshire
Comes six months after provider terminated prime provider function it
had been contracted to do
Virgin Care says CCG’s proposed budget for contract would have left it
with gap worth more than £1m to subsidise

Virgin Care has pulled out of a controversial contract with a
financially-challenged clinical commissioning group in the West Midlands,
HSJ has learned.

In a letter sent yesterday, the private provider told East Staffordshire
CCG it intends to terminate its community service contract after failing
to reach a funding agreement with the commissioner.

Virgin Care was contracted to provide community services for East
Staffordshire CCG under a prime provider agreement in 2015, worth £270m
over seven years. Under the contract, the CCG effectively outsourced its
responsibility for commissioning and integrating services for patients
with long-term health conditions and frail, older people to Virgin Care.
The company also provided some services directly.

At the time, the CCG told HSJ it had initially awarded the contract to the
company as it did not have the capacity to integrate services and that it
would become unsustainable without the deal going through.

The CCG said the prime provider model was used because expected increases
in demand and costs which Virgin Care would have to absorb over the seven
years of the deal. At the time the deal was signed, commentators warned
the contract would be handed back after an initial period due to the
savings required.

Following an 18-month dispute, the provider decided to terminate the
commissioning element of the contract in October last year.

The CCG and provider have since been in negotiations over the remaining
elements of the contract. These include community nursing, specialist
nursing, care coordination and care navigation.

In a statement, Virgin Care told HSJ it had not been able to reach an
agreement with the CCG over the budget it would need to meet local need.
According to the provider, it would have had to subsidise the contract by
more than £1m if it had agreed to the funding proposed by the CCG.

According to the provider, East Staffordshire CCG had proposed a contract
for around £9m, whereas previously the services were allocated £10m within
the contract.

In an interview with HSJ, Vivienne McVey, chief executive for Virgin Care,
said this would mean providing services for less than was they cost three
years ago.

Dr McVey added: “In the last year we have invested £1.7m overall. We have
continued to develop the hearing failure service, the diabetes service,
put more into the care co-ordination centre, introduced a pulmonary rehab
service and invested heavily in mobile technology for the community
nursing services.

“For the next 12 months, we will continue to deliver high-quality
services, then it is up to whatever the CCG provides. It will be up to the
new provider to provide what it is willing to, under whatever funding the
CCG provides.”

She continued: “We’re proud of what we achieved, but we have been unable
to agree sustainable future funding for the contract. As we are not able
to meet the difference between the funding from the CCG and what the
services cost to run, it is with a very heavy heart that we will step
aside and allow the CCG to develop its plans for the future.”

In a statement, East Staffordshire CCG said: “We can confirm that we have
received a 12-month termination notice from Virgin Care. They will no
longer provide community services under the Improving Lives contract from
9 April 2020.

“The CCG is keen to involve patients, clinicians and partners over the
coming months, before beginning a procurement process to commission a new
contract. The CCG remains committed to the principal of integrated
services that improve health outcomes for local people, in particular for
those with long-term conditions and for frail, older people.

“Our priority will be to ensure patients continue to receive high-quality
services during this termination period. We will also work closely with
Virgin Care to ensure staff are kept informed.

“The new contract is expected to be in place by 9 April 2020 and we will
work with Virgin Care to ensure a smooth transition for patients.”

Circle in court action against the NHS to protect their profits – Nottingham KONP fights on

Nottingham Keep Our NHS Public have been campaigning against Circle’s takeover of their hospital services for some time. Now though, there has been a significant development prompting the HSJ to write an article about how the local CCG is embroiled in a legal battle with Circle over a £320m contract.

In response to this news Nottingham KONP have issued the following release, and ask you to join them this Saturday for a march and rally with speakers. Assemble at 11am at the Brian Clough Statue in Nottingham and walk to Sneinton market to rally at 12pm.

Circle Healthcare, the private company currently running the Treatment Centre on the Queens Medical Centre hospital campus has begun court proceedings against the Rushcliffe Clinical Commissioning Group (CCG) to protect its profits.

Having lost out twice to the Nottingham University Hospitals Trust in the new contract to run Treatment Centre services, Circle is now going to court for a second time, claiming the Trust can’t possibly treat NHS patients for less money and that bringing the contract back in-house would be “unrealistic” and “not in patients’ interests”.

The controversial company has had a number of major failures in the past, including the collapse of acute dermatology services at the Queens Medical Centre hospital after they took over that contract and handing back the contract to run Hinchingbrooke Hospital near Cambridge in 2015 because they weren’t making enough profit.

Circle allege that the cost of in-house services would be higher due to staff benefiting from “improved NHS terms” – an admission that they are underpaying staff at present – and fail to mention the extent of the profit they have been taking out of the NHS for the past ten years. Both the CCG and NHS Improvement’s regional Director of Finance have approved the in-house bid.

Mike Scott from Nottingham Keep Our NHS Public said:

“This is completely outrageous. Having been fairly beaten to this contract twice by better value public sector bids, Circle have gone to court to try to protect their profits. Their past performance should have been enough to bar them from bidding for any NHS contracts. We will not stand by and watch them take urgently-needed money out of the public sector by the back door. These people only care about profit, not patients. This is nothing short of a national scandal.”

Keep Our NHS Public are continuing to highlight and challenge privatisation around the country every day. Join us and help save our NHS together.


Health visiting services on ‘knife-edge’ as systematic cuts take toll

Health visiting services in England are on a “knife-edge”, a nursing charity chief has warned, as staff numbers continue to plummet in the wake of systematic budget cuts. 

Dr Cheryll Adams, executive director of the Institute of Health Visiting (iHV), said an extra 5,000 to 6,000 health visitors were needed to be able to “deliver against the research” for early years care.

“There’s a very, very urgent need to invest”

Cheryll Adams

She cautioned that gaps in services were already leading to more children going into care and more growing up with mental health problems.

“The service is on a knife-edge, it has been for about 18 months,” Dr Adams told Nursing Times.

It comes as new figures from NHS Digital show that the downward trend seen in health visitor numbers in recent years has now reached a new low.

As of January 2019, there were 7,694 health visitors in England, a fall of 25% since their peak of more than 10,000 in 2015, when a perfect storm struck the profession.

That year saw the end of the government’s successful “health visitor implementation plan” to significantly boost staff numbers, and was also when commissioning of health visiting transferred from the NHS to local government.

Since then, budgets from central government to local authorities to deliver health visiting and other core public health services has fallen year-on-year, from £3.4bn in 2016-17, to £3.134bn in 2019-20.

In addition, new training places for health visitors were reduced by 22% in 2015, according to the Local Government Association.

The latest figures show that the workforce figures have hit the lowest level since September 2012.

However, the government insisted that the outlook was not as bad as the figures portrayed because they only included health visitors employed in the NHS and excluded primary care.

It said it was exploring ways to get better data on the workforce.

Significantly, as part of the NHS Long Term Plan, the Department of Health and Social Care is considering whether the NHS should take back some control in the commissioning of health visiting.

Dr Adams claimed that unless the commissioning model changed “there won’t be a service”.

She said the fall in health visitors was the result of both local authorities having to cut roles due to financial constraints and staff leaving, because of the pressures.

“What you’ve lost are senior, very skilled practitioners who assess hidden need before it becomes conspicuous,” said Dr Adams.

“What is happening now is that they are managing conspicuous need and safeguarding, and we know more and more children are going into care, so that situation is going to continue,” she said.

“Chronic shortages mean more health visitors are retiring early”

Fiona Smith

Dr Adams said the shortfalls in services were also resulting in more children developing mental health issues, more being taken to A&E, and more using general practitioners inappropriately.

“It’s not about to start to happen, it’s happening now,” she cautioned. “There’s a very, very urgent need to invest.”

The challenges were also taking their toll on staff on the ground, said Dr Adams, noting that sickness rates among health visitors were “climbing steadily” and that some were leaving the profession as a result of the working conditions.

In England, mothers are entitled to five mandated health checks from pregnancy to when their child reaches the age of two-and-a-half.

However, Dr Adams highlighted how the rules did not stipulate that the checks must be carried out by a health visitor, so some local authorities were relying on lower paid staff such as nursery nurses to tick the boxes.

A survey carried out by iHV in November found that 65% of families were not seeing a trained health visitor after their child was eight weeks old, she noted.

And, with the government signing off on another round of public health budget cuts for 2019-20, Dr Adams said there was a “real risk” that more health visitors would be lost.

She called for urgent reinvestment in services and for more money to be committed to training and developing new health visitors.

Meanwhile, Fiona Smith, professional lead for children and young people at the Royal College of Nursing, said the “central problem underpinning” the decline in health visitors was the local authority public health cuts.

She added that health visitors should be “central” to the government’s illness prevention agenda but noted that the momentum gained through the health visitor implementation plan in increasing numbers had been “lost”.

“There is still good uptake of the health visitor service and it remains valued by parent”


“Infants, children and their families deserve properly funded, accountable services delivered by a fully staffed nursing, health visiting and midwifery workforce backed by adequate resources,” said Ms Smith.

“Chronic shortages mean more health visitors are retiring early,” she said. “With the current state of play, nurses are choosing not to pursue this career option following qualification.

“Without proper workforce planning, the situation for children and young people will only worsen,” she warned.

The RCN is calling for safe staffing legislation in England that would hold ministers accountable for ensuring there were enough staff to meet patients’ needs.

A Department of Health and Social Care spokesman said: “There is still good uptake of the health visitor service and it remains valued by parents.

“Under the NHS Long Term Plan, we will consider whether there is a stronger role for the NHS in commissioning health visitors and will work closely with local government on this,” he said

Matt Hancock going ‘full steam ahead with NHS privatisation’; Americanisation of GP service in England

Dear All,

INews Saturday 6th April 2019.

Matt Hancock going ‘full steam ahead with NHS privatisation’

Labour party tells Health Secretary to focus on his job as it reveals 21 NHS contracts worth £127m are currently out to tender.

Labour has told him to focus on the NHS rather than any leadership ambitions.

Health Secretary Matt Hancock is proceeding “full steam ahead with NHS privatisation”, according to the Labour party as it reveals a total of 21 contracts worth £127m are currently out to tender.

The deals include a £91m contract to run an NHS 111/Clinical Assessment Service in the South East. Some £36m of new NHS contracts have been put out to tender in the last six weeks alone, according to new House of Commons Library analysis undertaken for Labour.

In February, shadow Health Secretary Jonathan Ashworth demanded Mr Hancock block private companies from securing 26 NHS contracts worth over £128m out to tender at the time after the latter promised “there would be no privatisation of the NHS under my watch.”

Mr Ashworth will today accuse the Health Secretary of breaking his promise and demand that he prioritises ending privatisation of the NHS by keeping these contracts in public hands, instead of “working on his own Tory leadership bid”.

The 2012 Health and Social Care Act obliges NHS clinical commissioning groups (CCGs) in England to tender out any contract worth over £615,000. This has led to a huge increase in the number of NHS contracts awarded to private firms such as Virgin Care. In 2017/18, some £8.8bn of the health service budget went to independent sector providers – a 50 per cent increase compared with 2009/10.

Private firms

In January, Mr Hancock said he supported the idea behind Access mydentist – an “affordable” alternative to NHS dental care which is being rolled out at a number of practices.

Labour said it was the latest in a “string of endorsements of private healthcare” by the Health Secretary. In November 2018, Labour’s former shadow Health Minister Justin Madders wrote to the Prime Minister expressing concerns that Mr Hancock may have breached the Ministerial Code by endorsing Babylon, a private healthcare company, in a paid-for-newspaper supplement. Babylon’s GP at Hand, of which Mr Hancock is a patient, has been roundly criticised by doctors’ groups “cherry picking” fit, young and health patients and financially destabilising traditional GP practice.

Earlier this week NHS England threatened to sue Oxford University Hospitals NHS Trust for libel, for raising concerns that privatising a key element of cancer treatment would endanger patients’ health.

Labour has pledged to reverse privatisation of the NHS and return the health service into expert public control, as well as repealing the Health and Social Care Act which puts profits before patients.

Speaking at the Health Campaigns Together Annual General Meeting on Saturday, Mr Ashworth will say: ““A few weeks ago the Health Secretary told MPs there would be no privatisation on his watch and yet we’ve seen cancer PET-CT scanning services in Oxford privatised, and today we’re revealing another £36m worth of contracts put out to tender in the last few weeks.

“Labour will bring an end to this profiteering in our NHS and restore our health service to public hands. Tory privatisation will be killed stone dead under a Labour government and we’ll bring forward the necessary legislation to reverse the Health and Social Care Act and reinstate a publicly provided NHS in our first Queen’s Speech.”

The Department of Health has been approached for comment.

See also Welfare Weekly.


Please listen to this if you possibly can – even part of it. The whole takes just under 60 mins. It examines the implications of the government’s newest plans for general practice (January 2019) – in particular to change from our current system to one which will prioritise cost over care. Many of you will relate it to your own recent experience.

It features two general practitioners and one consultant surgeon talking clearly and incisively about the Long Term Plan and the new GP contract.