If You Want to Save the NHS – Don’t Vote Conservative – May 2017


Issue: 48

May 2017


This occasional newsletter is researched, written and edited by a group of concerned residents in Ealing, West London who want to preserve our NHS. We view the wholesale engagement of private, for-profit healthcare service suppliers as unnecessary, profligate and dangerous. Increased funding  is what is needed in our NHS – not financial cuts, closure of vital services service or privatisation.


If You Want to Save the NHS – Don’t Vote Conservative

I am not a ‘party’ political animal and I have never been a member of a political party. However I’m convinced that five more years of a Conservative Government will result in the destruction of the NHS as I’ve known it since I became an adult in the 1960s.


The current Government’s Sustainability and Transformation Plans (STPs) will mandate the creation of Accountable Care Organisations (ACOs). ACOs will be private consortia of NHS, Local Authority and possibly private companies which will determine how and where money is spent for healthcare and social care. NHS bodies and Local Authorities will no longer hold the purse strings or push the management levers in the delivery of care. ACOs will be the fixed price, 10/15 year contract vehicles for cutting the national annual care bill by £22 billion.


The North West London STP, along with its aberrant precursor the NHS NWL Shaping a Healthier Future (SaHF) plan, will deprive Ealing – a town with more residents than Leicester or Sunderland – of a Major Hospital. The NWL STP will deprive the 426,000+ patients registered at the 76 Ealing GP surgeries of hospital A&E and Intensive Care services in the town. The number of beds at Ealing Hospital currently stands at 288. Under the Conservative party-driven STP this will be slashed to just 50 beds.


Under a ‘hard’ Brexit our new Tory Government might eject all EU/European citizens from the UK. EU/European countries might reciprocate and eject British nationals from their countries. The net result of this will be the loss of tens of thousands of care workers and the influx of thousands of new patients needing care.


I do hope that all Political Parties will explicitly spell out in their manifestos what their plans are for funding and improving care services. On 2 May 2017 the Shadow Health Minister revealed some of Labour’s NHS manifesto intentions. He said Labour, if elected, would stop the planned closure of hospital A&E units. He also said that Labour would introduce a moritorium on implementing STPs. The former intention will be clear to most voters whilst the latter won’t mean that much to the majority of voters who won’t have a clue what STPs are all about. Labour wants to set up ‘NHS Excellence’ which will be a new body which will involve local people in reviewing STPs.


Locally the Conservatives have made it very clear that they agree with Government Shaping a Healthier Future (SaHF) and Sustainability and Transformation Plan (STP) intentions to decimate Ealing Hospital. They are unwilling to admit that by reducing beds from 288 to 50, closing A&E, Intensive Care and Surgery what we will be left with not qualify as a hospital in any meaningful sense. Ealing Labour Party has made it very clear that they support the retention of Ealing District General Hospital and oppose the SaHF and STP proposals.


‘999 call for the NHS’ and Public Law Firm Leigh Day Launch STP ACO Judicial Review Initiative

This initiative will select a Clinical Commissioning Group (CCG) and request a Judicial Review (JR) of the CCG’s STP plans for new local NHS and social care organisations to operate ‘fixed, pre-set population budgets’. These so called capitated budgets will force the NHS to behave like an insurance company. Crowd funding is being used to raise £25,000.


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One of the issues with regard to a JR concerning ACO/MCP/ACP/LCO/PAC ‘models of care’ – which are the projected vehicles for implementing these fixed, pre-set population budgets  – is that there is scant information on any of these in any of the STPs that I have read.


What the STPs don’t spell out re ACOs and their variants include:

+ 10/15 year fixed price contracts

+ Specific service profiles for a specific population

+ Consortia made up of a variety of organisations including public, private, charity and voluntary organizations

+ Contract values in the £billions


Bids are In for a £6 Billion Accountable Care Organisation (ACO) Contract in Greater Manchester

This is the largest ever NHS services tender. A 10 year ACO contract is on offer for the provision of community health, social care, primary care, mental health and voluntary sector care services for 600,000 patients. The closing date for bids was 28 April 2017. The ACO was originally supposed to go live in April 2017 but now the projected start date is 1 April 2018.


The lucky contract winner will be referred to as a Local Care Organisation (LCO). Not included in the LCO services are so called ‘core’ GP services. The organisation ‘commissioning’ the LCO is Manchester Health and Care Commissioning – a non-statutory collection of the Manchester Clinical Commissioning Groups and the city Council. The commissioners are quoted as saying that the LCO is a strong part of Greater Manchester’s pioneering devolution arrangements. We all know how to identify pioneers don’t we – they are the folks with arrows in their backs.


One does wonder how much Manchester residents know or understand what this LCO is all about. One can only speculate how many residents were involved in the formative stages of conceiving the LCO Invitation To Tender – never mind in developing the concepts for the LCO. My guess is that no residents were involved.


At a national level it’s of great concern that the ACO/LCO concept has not been debated in Parliament and there is no Government legislation or regulations which legitimise this £6 billion undertaking.


Be Very Scared of Moves Towards PPPs and the ‘Alzira Model’

Hidden under the bonnet of many of the STP vehicles are some components with very chequered histories. Two of these are PPPs and the ‘Alzira Model’. The fact that both are being talked about by NHS England and their prime Accountable Care Organisation (ACO) NHS consultants PwC is worrying.


What is PPP?

PPP stands for Public-Private Partnership and is a funding model for public infrastructure and services. A PPP contract will be long term and will involve at least one public body and one private body. PPPs are used to conceal public borrowing while providing long term State guarantees for profits for private companies. In the NHS the most common PPP contracts are 30/60 year PFI contracts for hospitals. PFI interest payments are often so high that they threaten the financial viability of hospitals. The most spectacular PPP failure was the London Underground Metronet PPP. It failed in 2007 after just five years and cost the tax payer £410 million to bring the work back under public ownership.


What is the ‘Alzira Model’?

The Alzira Public Private Investment Partnership (APPIP) was created in 1997. Signatories to the partnership were the Spanish Valencia Government and RSUTE – a joint venture special purpose vehicle. The RSUTE shareholders were a medical insurance company and Spanish banks. The function of the APPIP was to construct a hospital and manage both the clinical and non-clinical facilities in the town of Alzira. Funding would be calculated by applying an annual ‘Capitation’ fee of 204 Euros per resident. This capitated budget approach is exactly the one favoured by all ACO undertakings. The hospital was built and began operating as La Ribero Hospital on 1 January 1999. As the first PPP hospital in Spain there was local hostility and initially few patients were referred to the hospital. High interest payments drove wages down and led to an unhappy workforce with union protests. Staff at the La Ribero Hospital had less job security, lower pay scales and longer working hours than staff at non PPP Spanish hospitals. One of the local banks involved became overstreched and went bust in 2001.


Following losses, the APPIP contract was terminated in March 2003. Clearly the capitation fees had been set too (optimistically) low. However nothing succeeds like failure and the Valencia Government had to pay RSUTE 69.3 million Euros on termination. RSUTE II sprang into life and paid the Government a premium of 72 million Euros for a new APPIP contract. The new contract was a bigger deal which served 245,000 inhabitants, offering primary and specialist care, managing 30 health centres and two outpatient clinics as well as the hospital. The annual capitation fee was initially 379 Euros/head (as opposed to the failed project’s 204 Euros/ head). There was even an annual capitation uplift every year! By 2012 the annual capitation had soared to 639 Euros.


Under RSUTE II there have been doctor shortages, staff dissatisfaction and a doctors’strike in 2007. There were also claims that RSUTE II ‘cherry picks’ the most profitable medical and surgical specialities, whilst referring HIV and other chronic disorders to other hospitals.


Much of this information has been extracted from two papers jointly authored by the University of Zaragoza and the University of Manchester/Manchester Business School. The authors found it extremely difficult to get hold of reliable and complete data on the financial performance of the PPP. However they conclude that the original RSUTE project was never going to be viable. As for the re-negotiated RSUTE II PPP, it has proved to be very costly to the Government.


The questions that must be asked include whether the PPP/Alzira Model approach is a viable way of achieving cost savings and or service improvement. The NHS paid for 20 Morcambe Bay clinicians to visit Alzira and study the functioning of the PPP in 2014. However there’s nothing in the NHS Morcambe Bay Vanguard that even vaguely resembles the Alzira Model. Maybe the clinicians weren’t impressed – and maybe that represents taxpayers’ money well spent on the trip.


Smoking Ban at Scottish Hospital Judged Unlawful by Supreme Court


On 11 April 2017, the Supreme Court overturned a decision by the Scottish Inner House of the Court of Sessions to implement a comprehensive smoking ban at Carstairs Hospital. Carstairs Hospital had previously implemented a truly draconian, comprehensive ban on smoking anywhere (inside or outside). The ban even extended to visitors being searched and having tobacco products confiscated.


Charles McCann, who suffered from a mental health disorder and who was detained in the hospital, applied for a Judicial Review to challenge the ban. The Supreme Court judged that Mr McCann’s rights under domestic law and Article 8 of the European Convention on Human Rights had been infringed. In effect the decision allows patients and their visitors to smoke in the hospital grounds.


Although this decision relates to a Scottish hospital let’s hope it encourages someone to challenge the idiotic no smoking anywhere ban implemented by the West London Mental Health NHS Trust.