Calderdale Save Our Services and the Calderdale 38 Degrees group lobbied the January 17th meeting of the ‘shadow’ Calderdale Clinical Commissioning Group (CCG) and urged them to do their utmost to keep the NHS as a publicly-provided service.
The new Health and Social Care Act requires that on 1st April 2013 Calderdale CCG will take over Calderdale NHS from Calderdale Primary Care Trust, together with Calderdale Council which will take responsibility for public health. The main role of Calderdale CCG is to commission health services – in other words, to decide who will actually provide services to patients and who will get paid for doing this.
There is a widespread public anxiety that these changes will privatise the NHS by the back door.
Buying private health services
Leafletting outside the Dean Clough F Mill in Halifax before the meeting took place on the 5th floor, Pete Keal of Calderdale SOS said,
“Calderdale SOS has been campaigning against the Health and Social Care Act and now that it’s been made law, we’re trying to mitigate its worst effects. Clinical Commissioning Groups are under a diktat from the Coalition government to follow the ‘Any Qualified Providers’ initiative and provide some services via private companies. We’ve asked Calderdale CCG to explain why they’ve asked private health providers to make presentations, and why they’ve asked Virgin Healthcare to take over the dermatology service.”
In the meeting, which was open to the public, Calderdale SOS got its answers. The Calderdale CCG Chair, Dr Alan Brook, said that the Group had not asked private health service providers to make presentations. Pete Keal pointed out that in summer 2012, Calderdale CCG had an event for private providers.
Dr Brook replied,
“Private providers aren’t invited into the Calderdale CCG Board, but Calderdale CCG does engage with private providers. We gave them an opportunity to talk to us. We listened to them, they did not have any part in decision making.”
Answering Calderdale SOS’s question why Calderdale CCG had asked Virgin Healthcare to take over the dermatology service, Dr Brook said that the CCG had put the service out to tender and Virgin Healthcare had put in the best bid.
Anyone who’s travelled on Virgin Trains might feel like reflecting that Virgin also put in the best bid for the West Coast train line and then proceeded to run a terrible and very expensive service.
“Performance and efficiency savings” and cuts to Calderdale NHS spending – rationing by stealth?
The Chief Finance Officer reported on cuts to Calderdale NHS spending over the last few years. Since the Health and Social Care reforms were introduced, Calderdale NHS has been told to cut running costs by 1/3.
For 2012-13 the Calderdale NHS budget was delegated to Calderdale CCG. The Department of Health set Calderdale a target to end the year with a £3.6m surplus, which Calderdale CCG is on track to deliver.
To achieve this surplus, in 2011-12 Calderdale CCG is looking for:
- increased productivity and efficiency savings of £5.6m
- reduced management running costs of £1m
According to the Green Benches blog, the 2013 Laing & Buisson Healthcare market review shows that in 2012 the private sector had 28% of the overall value of the UK health services “market”. This compares to 16% in 2009, according to World Bank figures.
First off, what are productivity and efficiency savings?According to the Audit Commission,
“The clinical productivity and efficiency category includes savings such as demand management, reduced length of stay, moving to day case surgery or outpatient treatments, bed closures and contract renegotiation. Pay and workforce includes reducing management costs, reducing overtime costs, vacancy freezes and decreases in the use of bank and agency staff, and changes to staff grade mix.”
In January 2011 the Royal College of Surgeons (RCS) produced a briefing report RCS Briefing – Procedures of a Limited Clinical Value – Jan 11 about the introduction of “rationing by stealth” through the introduction of the concept of “limited clinical value” – a term that NHS managers apply to procedures they no longer wish to fund. The RCS report states that, with cuts to NHS funding, this category now includes “many proven operations known to enhance health and improve quality of life“.
The widening use of this concept creates a rationale that allows so-called efficiency savings by reducing the number of services that Primary Care Trusts (and their successors, the Clinical Commissioning Groups) would have to commission/spend money on. In 2011, the Department of Health required the NHS to “save” – ie cut – £20bn by 2015. This represents a cut of about 5% in NHS spending.
The RCS report concluded that this “rationing by stealth” “…clearly is unacceptable, not in the long-term interests of patients and the NHS, and must stop.”
It would be interesting to know how much “rationing by stealth” the shadow Calderdale CCG has practiced over the last year, in order to make its £5.6m “productivity and efficiency savings“.
Calderdale CCG faces risk from transfer of specialist services commissioning to National Commissioning Board
Julie Lawreniuk, the Chief Finance Officer, said that under the Health and Social Care Act changes, Calderdale CCG will lose £25m for specialist services, such as heart transplants and dialysis. This is because in 2012-13 responsibility for commissioning specialist services will pass to a National Commissioning Board, which will delegate specialist services commissioning to Local Area Teams that cover a larger area than individual CCGs.
Calderdale patients will access the same specialist services as before, but the services won’t be provided by Calderdale CCG.
Ms Lawreniuk said that this transfer presents a risk to the Calderdale CCG, because it will lose £25m but may not get £25m worth of services from the Local Area Team. If it gets less than £25m of specialist services, Calderdale CCG will be out of pocket.
Calderdale Clinical Commissioning Group rejects proposed amendments to its Constitution
Dr Chris Day (not a medical doctor) of Calderdale 38 Degrees group submitted a written proposal to the Calderdale CCG, suggesting amendments to its Constitution that would allow it to consider ethical and social factors when making commissioning decisions, as well as financial considerations.
Before the meeting Dr Day told me,
“Privatisation would destroy the NHS. I’m here today because I believe in free health care for all and that applies to the next generation too. They should have the health care we’ve enjoyed.”
The 38 Degrees proposed amendments to the CCG Constitution would also allow Calderdale CCG to:
- improve accountability and democratic decision making by making sure the public’s voices are heard as part of the decision making process when commissioning, and that there is a stronger emphasis on disclosure
- set out a clear set of values for the future of the CCG
- strengthen requirements for transparency – both in terms of what information is placed in the public domain, and how people are informed about how to access it
- require a thorough review of conflict of interest instructions to ensure that all possible conflicts are covered by the constitution
The proposed amendments to the CCG constitution have been drawn up by specialist lawyers funded by the national 38 Degrees organisation. 38 Degrees has over a million members who campaign together for a more progressive, fairer society.
However in the meeting, Dr Matt Walsh, the Calderdale CCG Chief Officer, said,
“We’re not going to revisit the CCG Constitution. The issues that 38 Degrees are raising are more to do with procurement policy and strategies around procurement. This will be explicitly based on the NHS Constitution. This guarantees free health care at the point of delivery, but doesn’t guarantee that this care will all be provided from within the NHS.”
After the meeting, Dr Day commented,
“The amendments are really about protecting the Clinical Commissioning Group. They don’t seem to realise that in a few years time they’ll be out of a job and the whole NHS will be privatised.”
Closure of walk in services
Cllrs Faisal Shoukat and Jenny Lynn, both from Park ward in Halifax, sat in on the meeting alongside about 20 Calderdale SOS and Calderdale 38 Degrees members and supporters.
Cllrs Shoukat and Lynn attended because, as part of the Calderdale Council Labour Group, they are campaigning against the closure of walk in services in Todmorden and Park Ward. Councillor Shoukat said,
“There’s been no consultation. This is basically about the backdoor privatisation of the NHS.”
The Councillors are about to launch a petition against the closure of walk services, which they will present to Calderdale Council.
Lack of consultation over walk in service cuts – CCG admits “We haven’t quite done right”
In the meeting, Cllr Lynn asked the Calderdale CCG if they will consult with the public when services are going to be changed, for example the closure of walk in services in Todmorden and Park ward? Cllr Lynn said,
“This is to happen within a couple of months and there seems to have been no public consultation. How does this closure of services fit with your stated commitment to consultation over any significant change to services?”
Dr Walsh replied that he would send Cllr Lynn a written answer, but, briefly, he had taken advice about whether the proposed changes were significant and required consultation and was told no. He said Calderdale CCG would “reprocure” these GP sites and would “maintain an enhanced GP offer to these populations’ patients registered at these GP practices, with extended GP opening hours.” He added that Calderdale CCG was looking at strategic requirements for the next five years, including the matter of urgent, unplanned care.
“We have an absolute commitment to consult on this question. We clearly haven’t quite done right and we need to learn from that.”
Cllr Lynn said that it was likely that closure of walk in services would lead to more attendance at A&E, and asked for this to be monitored. She explained,
“Several people in Park ward are not registered with GPs – they are new arrivals, asylum seekers, Eastern European migrants and so on – so they won’t be able to use extended GP hours that Calderdale CCG has proposed as a solution to the closure of walk in centres.”
Consulted to death but with no input into decision making
Kate Smyth, lay member of Calderdale CCG on behalf of Calderdale LINk, said she had been consulted to death, but questioned whether public consultation really allows for public input into decision making. She said,
“It’s more about asking the public to comment on decisions that have already been made. Will public consultations about the future strategy of Calderdale CCG, and its governance and relationships to the Local Authority and the Health and Wellbeing Board and others remedy this?”
A Calderdale CCG member said that there wouldn’t be any NHS service users on relevant management committees, eg for different care streams (whatever a care stream is). Despite this, the Calderdale CCG Chair Dr Alan Brook asserted,
“Calderdale CCG has aimed to consult the public on real choices, not to present them with a done deal.”
The public were asked to leave the meeting so that Calderdale CCG could discuss unspecified private matters.
Going down in the lift, Calderdale SOS and 38 Degrees members said they were not greatly reassured by the meeting. Calderdale CCG could be doing little more than reorganising the deck chairs on the Titanic.