NHS privatisation exposed: Scale of treatment for paying patients at NHS hospitals revealed

An investigation by The Independent has exposed the extent of creeping NHS privatisation, leaving experts warning that state patients risk being sidelined as beds are diverted to private users.

Data obtained under Freedom of Information law shows income from private patients at one of London’s best-known cancer-specialist hospitals doubled in six years as the law was changed to allow NHS trusts to do more paid work.

Statistics quietly released by the Government show the situation is not isolated, with the total amount of income NHS England made from private patients leaping by a third between 2011-12 and 2016-17.

There is now growing concern that the NHS is involved in far more private work than previously thought, as much of it is masked from official records by complex operating arrangements with big private-sector health corporations which cream off profits.

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Open letter to Jeremy Hunt against NHS charging

New charging regulations are being introduced for overseas visitors. These, and their dangers and unfairness, are explained below. Please sign open letter to Jeremy Hunt before October 2nd.

We have a policy against NHS charging. There is already a charging regime, the Immigration Health Surcharge. At present according to the government websiteoverseas students outside the European Economic Area now pay £150 per year for use of the NHS as part of their visa application, and it costs £200 per year for all other visa applications. According to the Independent this will go up to £600 for migrant workers and £450 for international students, to cover their use of the NHS. According to the fact-checking website Full Fact, so-called ‘health tourism’ takes up around 0.3 per cent of the NHS budget and could include British citizens living overseas and returning to the UK for treatment.

What are the changes?

In August, the Government proposed to amend the ‘NHS Charging Regulations’, which govern how people access healthcare in England and when they have to pay for it. While there are already processes in place for hospitals to identify and bill ‘chargeable’ patients for their care, these regulations introduce two significant changes.

Firstly, under the regulations, charges have been introduced for services provided by all community health organisations in England, except GP surgeries. A wide range of health services will be affected, such as school nursing, community midwifery, community mental health services, termination of pregnancy services, advocacy services, and specialist services for homeless people and asylum seekers. Community-interest companies and charities will also now be expected to check whether the people using their services are eligible for free care, and charge accordingly. Public health services commissioned through Local Authorities, which include mental health and drug and alcohol services, are also likely to be affected.

Secondly, the regulations introduce up-front charging which means that every hospital department in England will be legally required to check every patient’s paperwork before treating them. If a patient cannot prove that they are entitled to free care (and if they do not qualify for free care under a treatment based exemption), they will receive an estimated bill for their treatment and will have to pay it in full before they receive any treatment other than that which is ‘urgent’ or ‘immediately necessary’, as defined by doctors on a case-by-case basis. The regulations require trusts to record that a patient is not entitled to free NHS secondary care against that patient’s NHS number. This measure, and up-front charging, were not included in Department of Health’s 2016 consultation on NHS cost recovery and as such have not received public scrutiny.

The regulations have been laid without evaluation of their impact on health outcomes and health inequalities, and without a full and robust assessment of the long-term costs to the NHS. Moreover, up-front charging has not been subject to any public consultation. These substantial changes to our national health service call for a much greater level of scrutiny.

We are concerned that:

· Up-front charging and the need to present paperwork proving eligibility for free care will increase barriers to healthcare for vulnerable groups – such as refugees, and people seeking asylum, homeless people, the elderly and those with mental health conditions – who are eligible for free care, but will struggle to prove entitlement.

· Additional bureaucracy will mean patient waiting times are likely to increase. There is also the risk of racial profiling being used as a means to identify chargeable patients, leading to an increase in health inequalities, and a failure to meet equality duties.

· These measures will cost the NHS more money. The only way to check eligibility for free NHS services which does not contravene equality law is to check everyone. Reviewing every patients’ immigration status will be time consuming, costly to administer and frustrating for both patients and NHS staff. The Government has not carried out a full and robust assessment of the cost of the new charging regime. Moreover, confusion over who is entitled to free care will deter patients from seeking medical advice at an early stage, leading to mounting costs for the NHS as conditions become more complex and difficult to treat and there is a greater reliance on emergency services.

· These regulations run the strong risk that healthcare, including lifesaving care, will be withheld from those unable to prove their entitlement to free NHS treatment or able to pay up-front, causing needless human suffering. Refused asylum seekers will be chargeable, but with no permission to work and often being entirely destitute, they will have no means of paying.

· The extension of charging into community care services, coupled with the likelihood that public health services commissioned through Local Authorities will also be affected by the regulations, will stop patients accessing the preventative care programmes which protect us all, including immunisation programmes, and services that enable the early diagnosis of communicable diseases.

What can you do? You can help by endorsing our open letter to the Secretary of State for Health, Jeremy Hunt (see below for full details). Please sign and ask your organisation to read and sign the Open Letter, and invite any health organisation or health professionals you know to do the same by Monday 2nd Oct: https://goo.gl/forms/0rBkQHy4H9fRmEMt2.

We have very limited time to halt these regulations and we need your help. Our aim is to get the government to withdraw the regulations and to this end, together with Doctors of the World, National AIDs Trust, Immigration Legal Practitioners Association, and others we’ve started an open letter to the Secretary of State for Health, Jeremy Hunt.

What we must do if our government won’t act to save our NHS this winter

NHS plans across England masquerade as ‘integration’ – but this autumn campaigners will meet to expose the reality now unfolding, of bed closures, private takeovers and a US-inspired system.

Ministers have ignored a strident “winter warning” from NHS Providers – the body that represents NHS and foundation trusts. The government is determined to stick to their plan to freeze NHS budgets for the decade to 2020 even as costs and population rise.

England’s hospitals and other NHS providers warned that if an extra £350m were not found by August at the latest, we will face another winter crisis even worse than the situation last year.

It’s the middle of September, and there’s no extra cash, and none promised.

Nor is there any let-up in the brutal 8 years of frozen or below inflation pay for more than a million NHS staff. Hospitals and community health services are finding it increasingly difficult to maintain hard-pressed services, so hospital bosses are now being threatened with the sack if they don’t meet A&E targets despite the struggle to retain and recruit staff.

Theresa May’s government opted not to contest a vote on scrapping the 1% cap. But May has made clear that she will ignore the will of Parliament, meaning NHS pay levels will be further eroded as inflation nears 3%.

The combined impact of these policies can be seen in Oxfordshire. 110 beds have already been closed with connivance of local councillors, and now the local acute hospitals trust has revealed a further 92 are now closed for “safety” reasons (presumably staff shortages). The county already tops the league for delayed transfers of care. The impact of spending cuts is a system seizing up and increasingly unable to maintain key services.

The quest for massive, unprecedented cash savings is of course the backdrop to the 44 Sustainability and Transformation Plans (STPs) secretively developed last year. These plans hinge on “new models of care” which appears to centre on cutting and de-skilling staff, and downgrading, downsizing or privatising key areas of care to cut NHS spending – while maximising openings for private companies to scratch out profits from under-funded services. There’s no evidence any of this will be effective, of course.

The current round of massive reorganisation and pressure for ‘new models’ is a bonanza for management consultants who are coining in millions and effectively now steering many Clinical Commissioning Groups and trusts.

The latest step was the publication last month of hundreds of complex pages of guidance and draft contracts for ‘accountable care systems’ (ACSs) and ‘accountable care organisations’ (ACOs) — explicitly drawn from privately-run systems that first emerged in the US. Jeremy Hunt has on several occasions stated: “We need clinical commissioning groups to become accountable care organisations.”

Pace-setters on this among 8 vanguard Accountable Care Systems have been South Yorkshire & Bassetlaw (where five Clinical Commissioning Groups have created a ‘shadow’ ACS without bothering to ask the five local authorities to sign it off. It will become a legal entity before April 2018).

In Nottinghamshire the Sustainability and Transformation Partnership is spending £2.7m this year getting bungling consultant Capita and US health provider Centene to help shape up an ACS.

In each case the reality will be an Accountant-Controlled System, focused primarily on cutting services to fit within a rigid cash limit. Nottinghamshire could even wind up giving the US company a contract to do the CCGs’ job, controlling budgets and services.

Neighbouring Leicestershire Sustainability and Transformation Plan leaders claimed the local authority backed their Accountable Care System. But the County Council has denied this, and it’s likely that many elected councillors and MPs in the other “vanguard” ACSs will be equally reluctant to take political responsibility for plans which masquerade as “integration” of services but threaten to bring only declining quality and restrictions on access to care.

The STPs and ACSs all lack any legal status to force through cuts. Councils still retain powers to challenge and force a review of decisions that represent a threat to local health care services – and they must be pressed to use them.

However politicians – like the wider public – will remain in blithe ignorance over developments in the NHS – unless campaigners can pile on enough pressure and present sufficient compelling evidence to make clear what is happening.

There is more and more evidence to show which way things are going. It’s reported in Healthcare Europa that NHS England has surreptitiously decided to award all six of the NHS contracts for organising the new “Integrated Care” models to private companies. All but one are American-owned – the other, OptiMedis, is from Germany.

If this proves to be correct, Tory politicians will find it even harder to convince suspicious voters that they are not destroying our NHS with cuts only to open the doors to the ultimate horror: US-style health care. Even NHS-run ACSs represent a huge retreat from a national NHS to 44 local plans each with rigid cash limits and no remaining accountability to local communities.

Theresa May’s team has adopted an ostrich-style response to the rising cash crisis and its likely impact this winter. But it’s clear that many of her MPs, fearing they could lose their reduced majorities at the next election, are pressing hard behind the scenes for a reprieve for local services.

MPs have already forced significant retreats from hospital downgrades in north Devon and Essex. Cabinet minister Andrea Leadsom has backed calls for a reprieve for hospital services at Banbury’s Horton General, and may yet have something to say about Oxfordshire’s latest bed closures.

Many more Tory MPs need to be confronted by local pressure to force this weak minority government to back off on cuts and new models – just as they have been forced to drop privatisation of NHS Professionals.

We urgently need to build a big enough and strong enough movement to force politicians to take notice if we are to avoid a further irreversible decline this winter and ever-deepening crisis in the NHS.

That’s why Health Campaigns Together has called for the biggest-ever gathering of health campaigners on November 4 in Hammersmith Town Hall in a conference that will share information and experiences, link trade unions, pensioners and campaigners, and build networks that can unite and concentrate the strength of local campaigns.

We have nationally known speakers and local campaigners – and lots of time for workshops, networking and discussion. Join us: book your place now!

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KONP Calls for Transparency in Warwickshire

Petition from Keep our NHS Public groups calls for Warwickshire health plan to have transparency

Norma Timms, North Warwickshire KONP, Martin Drew, South Warwickshire KONP, handing the petition to Andy Hardy, CEO of University Hospital Coventry and Warwickshire (UHCW) & Lead of the Coventry and Warwickshire Sustainability and Transformation Plan (STP) Board at a Healthwatch Warwickshire forum, Wolston Community Centre.

Campaigners have handed a petition to health bosses which asks for more transparency over the plan to shape the future of NHS services in Warwickshire.

At a Healthwatch Warwickshire forum discussing the Sustainability and Transformation Plan (STP) and the Future of Care on Monday, South and North Warwickshire Keep Our NHS Public (KONP) groups presented a petition containing almost 1,600 signatures to Professor Andrew Hardy, chief executive of University Hospital Coventry and Warwickshire (UHCW) and chairman of the Coventry and Warwickshire STP Board.

The petition calls on all the organisations involved in the Coventry and Warwickshire STP to “publish full details of the financial, workforce and site plans”.

The KONP groups have said: “We want to let the organisations know that we oppose any reduction in our health and social care services.”

“The public at large needs answers now about the STP’s finance, workforce changes and operational plans.

“Who is going to run Coventry and Warwickshire’s accountable care system or organisation (ACS/O)?

“In Nottinghamshire, the STP has awarded Capita £2.7m to set up an ACS. “KONP fears the introduction of the ACS/O is privatisation by stealth.

“Accountable’ does not mean accountable to the public, but accountable to a financial body ripe for takeover by American-type health insurance companies.”

Matt Western, MP for Warwick and Leamington, who has campaigned against cuts to NHS services, added: “Almost a year ago a few of us were urging the STP board to release information of the plan. When the plan was ultimately released, it was a vacuous piece of opaque report-writing which included no specifics but simply alluded to some possible areas of consideration. “We are now seeing the truth behind the plan and it is clear that the Government is pushing the NHS down the road of ACSs, while having to involve charities to provide certain care services in order to meet the real-term budget cuts being demanded. “Despite what it may say publicly, the Government is progressively privatising the NHS.”

A spokesman for Better Health, Better Care, Better Value, the Sustainability and Transformation Partnership for Coventry and Warwickshire, said: “We are committed to developing our plans for better health and social care services across Coventry and Warwickshire in partnership with the public and local stakeholders through engagement and consultation. “We want to work in close partnership with patients, the public and our staff. “As such, we welcome involvement from local groups such as South Warwickshire Keep Our NHS Public. We would encourage people across the local community to be involved in discussions around our plans as they are developed over the coming months and years.”

Read more at Leamington Courier.

South and North Warwickshire KONP Press release

South & North Warwickshire Keep Our NHS Public (KONP) groups presented a petition containing nearly 1600 signatures to Andrew Hardy, CEO of University Hospital Coventry and Warwickshire (UHCW) and  Chair of the Coventry and Warwickshire Sustainability and Transformation Plan (STP) Board, at a Healthwatch Warwickshire forum discussing the STP and the Future of Care at Wolston Leisure & Community Centre, on 11 September 2017.

The petition “Calls on all the organisations involved in the Coventry and Warwickshire Sustainability and Transformation Plan to publish full details of the financial, workforce and site plans. We want to let the organisations know that we oppose any reduction in our health and social care services”.

When questioned at the Healthwatch forum about the total lack of public engagement and detail of the STP since it was launched December 2016, and despite repeated requests from KONP, Healthwatch and local media, Andy Hardy admitted, “The launch of the STP could have been handled better.”  For example, STP responded to the Coventry Evening Telegraph’s Freedom of Information requests with, ”The STP cannot divulge commercially sensitive information” and ”the STP is not a statutory body”. There has been a total lack of transparency when it comes to consultation about the impact of the STP.

Apparently public engagement will now take place, as the STP adopts the US designed operating model of an Accountable Care System (or Organisation) (ACS/O). This was never announced at the introduction of the STP. It is a model that uses population numbers, with a fixed budget per head, instead of the founding NHS principal of Care According To Clinical need. It is designed to reduce hospital admissions  – allegedly through prevention and integration of all services involved in Clinical and Social care. GP practices and so-called ‘community hubs’ are supposed to cut costs by reducing hospital admissions and A&E consultations.

When questioned about the cost of setting up this totally new care model, Andy Hardy said, “The savings generated through efficiency and efficacy of the new model would lead to savings of £267 million by 2020”. However it was pointed out that there was already a 19% deficit in nurse vacancies at University Hospital Coventry & Warwickshire and major difficulty in attracting doctors into general practice. Training and changing work practices in a fully integrated care system will also be very costly and time consuming. The STP document itself concedes that lack of sufficient capital to respond to agreed changes may jeopardise the success of the new care system.

Andy Hardy said that ‘third sector’ (i.e. charities) will be a key factor in providing support services. SW & NW KONP fear that many health services, including many Out of Hospital Services will be moved out of the NHS into the social care sector which is subject to means-testing. While charities do a good job, substituting them for professional health and social care staff as a means of cutting costs endangers standards of care. Many third sector staff are either former professionals, on lower pay and conditions, while others have less training than nurses and social workers. Indeed this is precisely why we presented our petition to the Healthwatch meeting today 11September 2017: the meeting is aimed at the ‘third sector’ (charities and voluntary organisations) and how they can work in the STP.

The public at large needs answers now about the STP’s finance, workforce changes and operational plans. Who is going to run Coventry and Warwickshire’s ACS(O)? In Nottinghamshire, the STP has awarded Capita £2.7m to set up an ACS. KONP fears the introduction of the Accountable Care System/Organisation model is privatisation by stealth. ‘Accountable’ does not mean accountable to the public, but accountable to a financial body ripe for takeover by American-type health insurance companies.

Says Matt Western, MP for Warwick and Leamington, “Almost a year ago a few of us were urging the STP board to release information of the plan. When the plan was ultimately released, it was a vacuous piece of opaque report-writing which included no specifics but simply alluded to some possible areas of consideration. We are now seeing the truth behind the Plan and it is clear that the Government is pushing the NHS down the road of ACSs, while having to involve charities to provides certain care services in order to meet the real-term budget cuts being demanded. Despite what it may say publicly, the Government is progressively privatising the NHS.”

Commissioners tell STP they ‘remain sovereign’

Commissioners in north east London have told STP leaders they must remain sovereign organisations in wake of a new partnership agreement in the patch.

After seeking advice from lawyers, City and Hackney Clinical Commissioning Group has sent a letter to sustainability and transformation partnership leaders reminding them the agreement between providers and commissioners “does not create any new legal entity, and each organisation remains sovereign”.

The letter, sent on 7 June, was written in response to the East London Health and Care Partnership agreement, which was created in May and covers 20 organisations in the North East London STP patch.

City and Hackney and Waltham Forest CCGs are the only two NHS commissioners yet to sign the agreement.

In the letter, City and Hackney CCG makes clear the new partnership board must “talk to” individual CCG boards and adds “the governance at STP level needs to reflect the fact that organisations cannot be bound by majority vote”.

Although the partnership agreement said it does not intend to be legally binding it, it does propose that the board’s scope of authority includes “major system changes” such as the system control total and financial strategy, Whipps Cross Hospital redevelopment strategy and the system-wide estates strategy.

City and Hackney’s letter follows proposals for a single accountable offer to be appointed across the seven CCGs in north east London and raises concerns that commissioners will only have one representative on the partnership board.

It says: “In respect of the membership of the partnership board we note that this includes ‘nominated representative/s of east London commissioners.

“We assume that this means that the CCGs in east London collectively will be represented on the board by one person. This is at odds with the membership for providers and others, each of whom is represented by one person.”

A CCG spokeswoman said: “We are committed to delivering the best health and care services for the people of the City of London and Hackney – any changes to commissioning are always robustly scrutinised to ensure they enhance the CCGs ability to meet its statutory obligations.”

Rob Whiteman, chair of the East London Health and Care Partnership, said: “The partnership agreement is not, and is not intended to be, a legally binding commitment.

“Signed off by our partnership board, of which City and Hackney CCG is a member, it is essentially meant to support effective collaboration and trust between those involved to work together to deliver improved health and care outcomes and reduce health inequalities across east London. The agreement will be reviewed and updated regularly by the board to take account of any emerging good practice or development.

“City & Hackney CCG is yet to sign the agreement and we are in ongoing discussions with them about it.”

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