Image: Leo Reynolds/Flickr.
The schemes of NHS England boss Simon (don't stop me now) Stevens and Health Secretary Jeremy (I can't believe I'm still getting away with it) Hunt were well and truly exposed at the Health and Care Innovations Expo in Manchester last month.
Stevens started his keynote speech by boasting about his new beard. But his macho stance faltered when in the question and answer session I asked how Tameside, an area with one of the worst health outcomes in the country and with high levels of social deprivation, could possibly provide the improved health and social care services promised in his 'Sustainability and Transformation Plans' (STPs). I highlighted social services budgets being cuts by 50% and further STP-driven cuts to NHS services and hospital beds.
You don’t know much about STPs? That’s not surprising. Stevens and Hunt are trying to make us believe they are "engaging" with the public. But during Expo sessions it became clear they don't want the general public to know anything - or as little as possible - until the plans are officially approved this Autumn (with new contracts to be signed as soon as possible after that).
The ‘public' they do allow to glimpse the plans so far are often contracted by the system, eg Healthwatch and voluntary organisations, dependent for their existence on Department of Health funding. All such 'consultations' have been like this: open 'engagement' doesn't exist. In fact, it's being actively discouraged, as Shropshire found out when it got firmly slapped on the knuckles for making its plan publicly available.
So, those STPs. Stevens has divided England into 44 regions or "footprints", each with – as Expo revealed – new legal arrangements. Many fear Stevens’ decade working in the US for a private health insurance company has influenced his, and thus the NHS’s, renewed enthusiasm for local NHS’s to become ‘Accountable Care Organisations’ (ACOs). ACOs are an American idea exemplified by not so admirable firms like Kaiser Permanente (whose practices were devastatingly exposed in Michael Moore’s film ‘Sicko’).
Such organisations are ripe for privatisation, as Professor Allyson Pollock explains here.
We won’t fall for that, will we? We won't let our beloved NHS be carved up into greedy insurance schemes, with the 44 regions becoming effectively separate companies, running different services, with different pay rates and conditions of service – will we?
We won’t be distracted by the efforts Jeremy Hunt and his largely obliging media has put into provoking junior doctors, into destroying our respect for medical staff and into damaging our trust in the NHS – will we?
Already we learn recently that GPs in some areas have been told to encourage patients to claim for treatments via private health insurance, to save the NHS money (STPs again - each area has to make cuts in any way they can). And I also learned at Expo that some GPs are reducing their working hours to avoid paying rising indemnity fees. What a mess!
Many of the Expo delegates seemed sceptical - and disturbed – by just what ‘innovation’ is being served up here. But others are gullible. At least one bought an electric massager for £140 that is just 2 sets of 3 gobstopper sized balls going round in a circle. Rather like a lot of the magical sounding digital apps and gadgets being marketed there: they sound great - but human medically trained eyes and fingers can probe and analyse (and massage) far more efficiently than machines and algorithms.
Do we really want doctors and nurses replaced by robots? And ourselves reduced from individuals into just a set of symptoms by all these for-profit data collecting systems? They want social care information included now too. Confidentiality risks becoming an anachronism.
I ask three chaps of a certain age if like me they feel they've heard a lot of what's being said at Expo before. They laugh and agree. "It's a load of bullshit", one tells me. They agree that although the 'r' word - 'reorganisation' - is not being used, it is the best way to describe what's going on. "We've been here before so many times" one says ruefully.
Elsewhere a nurse comments that many of the "new" models being proposed are not new at all. Funding for many invaluable community-based support activities has been progressively cut by cash-strapped local authorities. Now, hey presto! - the same activities, such as gardening for people with mental health issues, are being proposed and hailed as a "creative" new solution: "New Models of Care". Though this seems mostly to be about the NHS ‘signposting’ such activities where they still exist, rather than actually restoring their funding. I propose a glossary at future such events. Changing the name of something does not change what it is!
I begin to feel my mental health is being threatened by such time-wasting duplicity. The jargon's getting to me, like maggots gnawing at an apple. We have to get out of our silos, they say, sitting happily in the new one they've built for themselves. And they know its foundations aren't secure. One hints that if STPs don't work - and there's no evidence to show they will - another scheme will be dreamt up.
One hospital manager tells me that figures used to show how much money would be saved when his STP footprint cuts its levels of addiction, had simply been made up. Another STP's plan to save money is to increase the longevity of some residents by 3 years. Cynically I wonder if the opposite approach would save more money.
Which brings me back to bullshit. That's the word the GP next to me used after Stevens' reply to me at the Expo. Which was: "Errrm, well, in 2020 Tameside will receive whatever cash its footprint (Greater Manchester) allocates to it. I'd asked the GP: "Reasonable reply? Or bullshit?” He didn't hesitate.
I ask the same question about how Tameside can possibly do more with less, of Stevens’ colleague Matthew Swindells – also fresh back from working in the States.
Swindells tells me that he and Stevens have told the Department of Health that the NHS needs more funding.
So why does Stevens – and the army of NHS England staff also there - waste time on such Expos (sponsors: Accenture and Boots)? Why are they giving their blessing to the £millions being spent on management consultants, and costly market solutions? And why are there clearly future plans to further involve private companies and Americanised delivery and finance models in 'NHS' provision? Recently Hunt admitted that Kaiser-style financial incentives were something the STPs were “designed to enable to happen’, and NHS strategy chief Michael MacDonnell told the private sector the STPs gave them ‘enormous opportunity’.
Why did Swindells assert the 'N' in NHS is safe, when clearly each footprint will have different legal contracts? He says their legal obligation to provide services will remain. Well, that’s what they told us about Local Authorities after the 1990 NHS and Community Care Act was enacted – so what they did was to locally tighten eligibility criteria. You now have to be virtually immobile and/or severely ill or disabled to even be assessed for social care support. Is this the way health services are headed? It seems they no longer think we should expect the state service we’ve been paying for all our working lives to provide the healthcare we need.
It's enough to drive one to drink...but of course that wouldn’t fit with the message of ‘being responsible for one’s own health’… sigh…