Stephanie Clark finds ambitous promises but an ongoing threat of outsourcing
Under assault from 10 years of ruthless ‘austerity’, fragmentation and creeping privatisation, NHS England’s Long Term Plan (LTP), launched on 7th January, now promises an NHS ‘fit for the future’.
But what is the reality behind the promises of transformation and ‘integrated care’?
The Plan presents huge ambition:
- to prioritise for investment mental health, the major killer diseases, maternity, neo-natal and child and young person’s health care;
- to improve public health through addressing the causes of ill health (though not the impact of 10 years of austerity!) through a focus on prevention of ill health, including through ‘self-care’;
- to address health inequalities.
There is wide support for these ambitions, but what in the plan is for real and what is aspiration or, more accurately, window dressing?
To start with three stark and shocking omissions: there is no workforce plan, no funding plan, and no plan for social care.
To put this in context, deliberate Government underfunding has caused:
- two-thirds of NHS hospital trusts to go in the red
- A&E in crisis and bed shortages at unsafe levels
- a massive and rising £8 billion maintenance backlog across the NHS
- targets routinely missed, including for cancer treatment
- average waits for GP appointments now two weeks
- rationing of treatments – for example: withdrawal of hip replacements, operations for cataracts and ‘non-life threatening’ hernias
- a workforce crisis – 100,000 vacancies in health and 150,000 in social care
- a social care system on the brink of collapse.
There are 60 uncosted plans in the LTP. And the LTP does not even identify the number of health care facilities that will need to be built and the capital funding for this. The Chair of NHS England’s January Board meeting admitted “we cannot begin to deliver the Long Term Plan without the workforce to do it”.
So, is it all pie in the sky?
There are some concrete plans that will be implemented: namely increased funding for mental health – a welcome commitment – but with implied cost-cutting elsewhere.
A digital revolution
Digital technology will transform access to health services – from online information for delivery of ‘self-care’, to access to GP by Skype App. Alarmingly, this ‘right’ is not matched by any right to a face to face appointment with your GP. Amidst the promise of artificial intelligence and an NHS digital future, there is dystopia in the making, a threat to personal data confidentiality, and a vast profit potential for the tech companies.
The reorganisation of GPs into centralised ‘hubs’ means GP practices will be forced to merge, turning 7,500 practices into 1,500 super practices covering populations of between 30-50,000, and reducing patient access and personalised care.
Top down restructuring – and the end game for the NHS?
The threat to the NHS is not just from underfunding, but also from privatisation.
Much has been made in some of the media of the LTP’s commitment to find a way around the 2012 Health and Social Care Act’s requirement to put out to tender all commissioned services, recognising the chaotic waste involved. No-one will now speak up for this disastrous Act.
However, central to the LTP is the development of Integrated Care Providers (ICPs). An ICP would hold the contract for the integrated delivery of hospital, community and GP services, and social care in each of 44 NHSE-designated health care areas, established since 2016, with a budget fixed per head of the area population. An ICP would commission the services but could also be a provider. An ICP would have no accountability to the community of its area or be subject to local authority scrutiny. Its sole accountability would be upwards to the regional directorates being set up now by NHS England.
There is nothing to prevent a private company winning an ICP contract. Ultimately, the plan to move towards large, ten-year (or more) regional contracts could threaten the wholesale outsourcing of the English NHS to private, and potentially foreign, interests.
The LTP makes clear that establishing ICPs is central to its plan. The direction of travel can be seen in the changes brought in under Simon Stevens, head of NHS England, and championed behind the scenes by the Secretary of State, Jeremy Hunt and now Matt Hancock, and more generally in the 30-odd year opening up of the NHS to the market.
Let us not sit back and let this happen.