A Trojan Horse? Keep Our NHS Public examine the government's Integrated care proposals

The case for Integrated Care seems obvious - who could be against integration it if improves the care of citizens? Keep Our NHS Public look beyond the initial favourable reception of the proposals and examine the prospect of them opening up the potential for more private involvement in the NHS LINK

FROM KEEP OUR NHS PUBLIC

In the middle of the Covid pandemic, when the NHS and its staff are going flat out to cope, NHS England (NHSE) is stealthily transforming the NHS again. What is portrayed as an innocuous move to ‘integrate’ care and reduce bureaucracy will, in effect, move decision-making even further from local communities and increase the presence and influence of the private sector in the NHS.

At the moment, the main tools for this transformation are Integrated Care Systems (ICSs), supported by plans for new legislative powers.  Although ICSs are already in place in some parts of England, a new document from NHSE provides the clearest glimpse so far of what ICSs could mean.

The proposals, recently echoed in a government White Paper, are of huge concern. Although seen by the media as suggesting the role of the private sector will be reduced, the proposed legislation, if passed, will enact the current government’s wish to further fragment, destabilise and privatise our NHS.

Background

Regulations brought in by the Health and Social Care Act (HSCA) of 2012 enforced a new competitive ‘market’ within the NHS.  The Act also introduced Clinical Commissioning Groups (CCGs) that were required to put clinical and other services out to competitive tender and so allowed increased private company involvement in the NHS.

Since then, while still retaining the market system, NHSE has declared that competition is to be replaced by the “integration” of NHS, local authority and other service providers. NHSE’s ‘integration’ has involved fragmenting the NHS into 44 areas (originally called ‘Sustainability and Transformation Plans’) destined to eventually morph into 42 Integrated Care Systems. The NHS Long Term Plan requires every NHS organisation and their local ‘partners’ to become part of an ICS by April of this year.

What are ICSs?

According to NHSE, ICSs are bodies in which

“NHS organisations, in partnership with local councils and others, take collective responsibility for managing resources, delivering NHS standards, and improving the health of the population they serve.”

The ‘others’ they refer to include private companies. An ICS will have a ‘single pot’ budget and its partners will collectively decide how to delegate that budget to loosely defined local “places” within the ICS.

Legislative change

The powers of ICSs are currently under review. NHSE argues that existing law, such as the HSCA (2012), does not provide a sufficiently firm foundation for the work of ICSs, so they propose scrapping Section 75 of the Act, which, for example, requires commissioners to put any contract worth over £.615,278 out to tender. They have also sought views on two options for enshrining ICSs in legislation.

Both options provide an ICS Board and a single ICS Accountable Officer. In one option, there would be a single Clinical Commissioning Group (CCG), along with a new duty for providers, such as NHS Trusts, to comply with the ICS plan. In the second option, NHSE’s preference, CCGs would be ‘repurposed’, whatever that means, and their commissioning functions transferred to the ICS Board. While the veto of individual organisations within the ICS would be removed, the ICS could delegate responsibility for arranging some services to providers “to create much greater scope for provider collaboration”.

What are the main issues for campaigners?

ICSs raise multiple issues but we focus on three main areas: the increased potential they offer for private companies to profiteer from the NHS; the unequal partnership they create with local authorities and the subsequent threat to social care and public health services; and the loss of accountability.

• Increased scope for private companies

Removing Section 75 of the HSCA (2012), by itself, won’t reverse the marketisation of the NHS. Worse still, it would involve revoking Procurement, Patient Choice and Competition Regulations, so turning the NHS into an unregulated market.

The proposals also recommend that NHS services be removed from the scope of the Public Contracts Regulations 2015, allowing commissioners more discretion when procuring services. It means that ICSs would be able to choose whether to award a contract directly to a provider or go through a more formal procurement process. Such flexibility massively increases opportunities for cronyism, as shown during the Covid pandemic when emergency measures allowed the usual procurement rules to be bypassed.  For example, the National Audit Office found that during the early stages of the Covid crisis, companies with ‘connections’ (for instance with government officials, MPs, or senior NHS staff), were ten times more likely to be awarded a contract than those without such links – even if they were entirely unsuitable suppliers.

The possibility that ICSs, operating in a market system, can chose to dispense with formal procurement processes is additionally alarming as NHSE wants to give each ICS a free hand in appointing its governing Board. This means that these Boards could include representatives from private providers – a move that’s described as “a blatant undermining of the ICS as an NHS body”.

The way that ICSs are to be internally managed will also increase privatisation. NHSE has accredited 83 companies to provide support for developing and managing ICSs through what’s known as the Health Systems Support Framework (HSSF). In the words of NHSE,

“The Health Systems Support (HSS) Framework provides a quick and easy route to access support services from innovative third party suppliers at the leading edge of health and care system reform”.

These companies, as you might guess, include McKinsey, Deloitte, Optum, IBM, Ernst and Young, Centene, and other global corporations, along with some UK and European companies, and a handful of NHS Commissioning Support Units.

The HSSF is divided into 10 ‘Lots’ covering services such as patient record systems, transformation and change support, capacity planning support, patient empowerment, and digital tools to support system planning. As NHSE points out,

“The Framework focuses particularly on services that can support the move to integrated models of care based on intelligence-led population health management. This includes new digital and technological advances that help clinicians and managers understand a population’s health and how it can best be managed.” (Our emphasis)

Population health management (PHM) is described by NHSE as “an approach aimed at improving the health of an entire population and improves population health by data driven planning and delivery of care to achieve maximum impact for the population.”

Briefly, PHM (“the critical building block for integrated care systems”) relies heavily on the mass collection and analysis of data from across multiple care settings, and a shift from care provided by clinicians face-to-face, to much more digitally provided care via remote consultations and algorithms. This inevitably means more private sector involvement due to the capital investment required for digital infrastructure, not to mention increased access to patient data for tech companies.

In addition, PHM shifts the focus of the NHS from delivering universal comprehensive care to individuals towards achieving data targets for the population covered by the ICS. Depending of course on how, and by whom, and with what aim, those data targets are set, what’s “good” for the population may be at odds with the needs of an individual.

• The threat to social care and public health services

ICSs are an essential part of a shift towards a ‘place-based approach’ to health and social care, with ‘place’ often seen as coterminous with local authority (LA) boundaries. According to the NHS Confederation, this level of working is the right scale for tackling ‘population health challenges’, such as health inequalities. A ‘place based approach’ is also part of a shift towards PHM, as well as shared responsibility for resources and service changes across all public services within the area.

NHSE proposals suggest that ICSs become the means for more ‘integration’ between the NHS and LAs. However, in its response to NHSE’s proposals, the Local Government Association (the national voice for local government) raises concerns that ICSs won’t be a partnership of equals across the broader health, wellbeing, and social care system. Instead, ICSs will be NHS-led, allowing a power grab that brings LA resources such as capital assets and funding for social care and public health under ICS (and thus NHS) control. There is also a risk that power won’t be devolved to local systems. Rather, central control will remain, with missed opportunities for real collaboration between the NHS and LAs to address the wider determinants of health, such as affordable housing and a safe environment.

Further, KONP among others has highlighted the risks posed by NHS management of social care. Social care is not an adjunct of the NHS, but has a very wide remit that overlaps with wider local authority responsibilities including housing, leisure, planning and education. In addition, social care is means tested while NHS care is (largely) free at the point of use and funded by taxation. If ICSs take on social care, they will have to develop complicated charging mechanisms. This could pave the way to charges for NHS services or, long term, for the introduction of a private insurance-based system (facilitated, incidentally, by the extensive data sets created by PHM). NHSE’s proposals also fail to mention any safeguards to prevent services that are currently free from being redefined as social care and so subject to means testing.

• Loss of accountability

 In contrast to local authorities, ICSs are not subject to democratic control. NHSE’s proposals will give them the power to create publicly unaccountable joint committees, potentially including representatives from private business, to make legally binding decisions about major resource allocation and service provision.  (For KONP’s vision for achieving democratic accountability, see here.)

CCGs, with their responsibility to manage local budgets, will be weakened or, as NHSE would prefer, abolished. In the absence of any plans to make ICSs accountable to local residents or patients, it seems that people over large areas of England will be disenfranchised. Although ICS Boards will supplant existing public bodies, there appears to be no requirement for them to meet in public, publish their Board papers and minutes, be subject to the Freedom of Information Act, or to have any democratic participation from the communities they cover.

What can we do?

KONP calls for a halt to the development of ICSs until there is a full consultation with the public, local authorities and Parliament. It argues that not just Section 75 but the entire Health and Social Care Act (2012) should be repealed and the NHS Reinstatement Bill laid before Parliament. This proposes restoring the NHS as an accountable public service; ending contracting and the purchaser-provider split; and re-establishing public bodies and public accountability to local communities.

We call on Councillors and MPs to be briefed in detail on the issues before legislation is tabled, and to be ready to challenge it.

We call on activists to make these issues a campaign focus, before legislation is tabled.

Covid cases down in Brent but still above average for England

 

Source BBC LINK

Petitioners urge TfL to treat trackside green corridors as an ecological asset - please sign

 

A petition has been launched asking Transport for London to take a more ecologically sensitive approach to trackside maintenance. Safety must be considered but there is no justification for a scorched earth approach. Clearances like the above have already been seen along our stretches of the Metropolitan, Jubilee and Chiltern lines.

Introduction to the petition

TFL contractors have been repeatedly reported removing miles of trees and vegetation running along London’s Underground tracks, most recently along the Metropolitan and Chiltern Lines. These acts of environmental vandalism mean rich, green corridors are severely reduced, impacting residents’ health and mental well-being, as well as removing biodiverse habitat for local wildlife.  

 

With 55% of the London Underground track network recorded above ground, we recognise a need for trackside vegetation maintenance, but the actions of TFL contractors are often excessive and unnecessary. 

 

They are treating these rich, green corridors as more of a liability than an ecological asset in which to invest. 

 

London Underground’s existing green infrastructure amounts to 10% of all green spaces in the city and is an obvious way for the Mayor of London, Sadiq Khan to meet his commitment to improving London’s “biodiversity and ecological resilience” and become the first National Park City. We are in a climate and biodiversity emergency and both the Transport for London and Sadiq Khan must do everything they can to protect the habitat and wildlife we have remaining in London.  

 

To: Mayor of London, Sadiq Khan

We call on TFL and the Mayor of London to commit to the following:

1. Immediately stop the excessive removal of vegetation from trackside TFL embankments. 

2. Ensure that TFL carries out biodiversity surveys before trackside work begins and that these are made easily accessible to the public. 

3. Ensure that local residents are informed in good time before trackside work begins and given time to feedback questions and concerns to TFL.

 
4. Ensure that TFL contractors are trained in effective vegetation management and biodiversity preservation.

Please act now and protect out vital green trackside spaces and wildlife in London.

SIGN THE PETITION USING THIS LINK

Brent Trades Council Meeting: "Toward Zero Covid: a campaign to beat the pandemic in Brent" - Wednesday February 24th

 

Brent Trades Council's next meeting will be an online rally "Toward Zero Covid: a campaign to beat the pandemic in Brent" on Wednesday February 24th at 7pm.

Our panel of speakers include :

 

Helen O'Connor, GMB and ex-nurse, who leads on this campaign on the People's Assembly

Shelly Asquith from the TUC who has been invited to speak on the importance of unionisation and working with Labour councils

Dr Jonathan Fluxman from Unite Doctors branch on the proposed campaign in Brent urging Brent Council to provide hotel accommodation when a family member needs to self-isolate .  Households are the most common place for spread of the virus and we have many low-income overcrowded households in Brent, an important reason for the high death rate in the borough.   

 

Patrick Vernon (OBE and member of Unison). He will address the difficult question of vaccine hesitancy. Amongst other achievements, Patrick was awarded an OBE in 2012 for his work on tackling health inequalities and was included in the 2020 Power list of 100 influential Black People in Britain.

 

ZOOM LINK

Cladding: Help or Betrayal?

 

 Before Robert Jenrick's announcement yesterday on cladding, local #EndOurCladdingScandal campaigner Lucie Gutfreund asked on Twitter whether it would be 'Help or betrayal?'

For many it looks like betrayal for those living in blocks of under 18 metres in height who will be faced with 50-60 year loans to pay for remedial works.

Lucie said on Twitter:

Apart from the cost not being affordable, what is important to also raise is that the £50/mth loan for 30-60 years will make their homes devalued and unsaleable and wipe out the leaseholders' equity if they need to sell their home, and many do need to!

She said she felt disgusted by Jenrick's treatment of leaseholders and his brazen claim that he understands the plight of leaseholders.

 

Cllr Shama Tatler, Brent Council Lead Member for Regeneration, Property and Planning  tweeted:

 

The government  announcement is simply not good enough. Leaseholders should not bear the costs.

 

The monies made available for higher blocks is only for cladding and not for the many other safety faults that have been found including lack of fire breaks, cavity wall insulation and of course the cost of waking watches.

The Fire Brigade general secretary Matt Wrack said: 

From the very start, firefighters and residents have warned that the building safety crisis goes far beyond the flammable cladding that was on Grenfell Tower.

This funding falls far short of the estimated £15bn needed to end the crisis. The government’s piecemeal and patchwork approach – designed to shield itself from responsibility – is wreaking havoc on the lives of millions of innocent people.

The government has sent a clear message that it cares more about their friends and donors in the housing and construction industry than residents trapped in dangerous buildings below 18m or the tens of thousands more with other serious fire safety defects.

A number of new build residential blocks across Brent are affected along with student accommodation in Wembley Park. Forum House owners have been told  by First Port that assessors have found it is eligible for funding for remediation work including render finishes and insulation layers as well as ACM cladding.

Quadrant Houseowners have been told that the report by an independent engineer found that the building can only be granted a B2 EWS form at present which would not satisfy mortgage lenders. Further remediation work may be needed on the external wall in order to gain a full EWS form acceptable to them. Meanwhile the engineer has said further fire alarm installations and a waking watch are not required.

 

Bobby Moore Bridge tile murals – a “dodgy deal” behind the scenes?

 Guest blog, by Philip Grant in a personal capacity:

A year ago, I wrote a guest blog which urged readers to go and see three tile mural scenes at Olympic Way in Wembley Park while they still had the opportunity. This also highlighted the possibility, mentioned in an email I had received from Quintain, that the “footballers” mural scene in the subway might still be covered up on occasions.

 

The “footballers” mural last week (on my way to get 

 first Covid-19 jab!)

 

I raised that question in an email to Brent’s Chief Executive and Council Leader on 16 February 2020, saying:

 

‘This "footballers" mural was meant to have been put back on permanent public display last autumn. The prospect of it being covered over with adverts again, particularly when England are playing at Wembley Stadium during the UEFA 2020 tournament, should be unthinkable!

 

I hope that Brent Council will do all within its power to ensure that the "footballers" mural, which includes the plaque unveiled by Bobby Moore's widow in September 1993, remains uncovered, particularly during England's UEFA 2020 matches at the Stadium this summer.’

 

 

A letter from Carolyn Downs on 2 March told me that 'the lease does provide Wembley Park with the scope to cover the footballers mural with advertisement dressing at certain points during the year, should a commercial opportunity arise.' I responded by telling her that although the lease might say that, the 2019 advertising consent did not allow the footballers mural to be covered. 

 

Ms Downs passed my reply to the Council’s Operational Director (Regeneration, Growth and Employment) to deal with. I explained in detail to this officer why the various planning and advertisement consent decisions did not allow adverts over the footballers mural. Her response was curt:

 

‘We have already set out our position on this. We disagree. I do not therefore intend to continue this dialogue.’

 

By that stage (23 March 2020) the country had just gone into its first Covid-19 pandemic “lockdown”. I decided not to raise a formal complaint, as Brent’s Chief Executive had more important things to deal with. I put this issue “on hold”, saying: 

 

‘'I will not pursue the point in this correspondence now, but may return to it once we are through the current emergency.'

 

One of the reasons why I have been campaigning, with fellow Wembley History Society members and others, to get all of the Bobby Moore Bridge tile murals put back on permanent public display is this. They are a colourful celebration of Wembley’s sporting and entertainment heritage, specially installed in 1993 as a work of public art welcoming visitors to Wembley Park. 

 

2023 will mark the centenary of Wembley Stadium, and the 75^th anniversary of the 1948 London Olympic Games, for which Olympic Way was constructed. What better way to mark those milestones than to let residents and visitors enjoy those murals again? After all, the Council had (finally!) recognised the importance of ‘the heritage tiles at Wembley Park’s Bobby Moore Bridge’ at the start of Brent’s year as London Borough of Culture 2020, saying:

 

‘The tiles, which show scenes from famous sports and entertainment events at Wembley Stadium and the SSE Arena, Wembley, are part of Brent’s rich heritage and date back to September 1993 when they were originally dedicated to the legendary footballer.’ 

 

Cllr. Butt, the Mayor and other guests at the LBOC 2020 tile murals reveal, 18 January 2020.
[Photo by Francis Waddington]

 

I was hoping to persuade Brent’s Cabinet, when the Bobby Moore Bridge advertising lease came up for renewal later this year, to consider the option of only allowing advertising on the large display panels on the bridge parapets. This would give the opportunity to remove the light boxes currently covering most of the mural scenes in the subway, possibly using some of the CIL funds which the Council is sitting on to fund that work.

 

I wrote to Brent’s Chief Executive on 4 January, setting out my suggestions for how the Council could go about this, so that Cabinet members could be given a choice of options when the lease came up for renewal in 2021. You can imagine my surprise, and disappointment, when I received the this reply from Ms Downs the following day:

 

‘The lease for Bobby Moore Bridge was recommended for a three year extension from 30 August 2021 and expires on 30 August 2024.  This was completed in November 2019 after market appraisal was carried out by an independent advertising consultant who recommended the lease extension on the basis of market conditions at the time and the leaseholder’s ambitions to refurbish the area and upgrade the panels to digital screens.’

 

It didn’t appear that the Cabinet had approved this, so how did it come about, who authorised the lease extension, and what authority did they have to do so? I submitted a Freedom of Information Act request, and while I have yet to receive all the items I asked for, I have received redacted copies of three documents. 

 

One document is a “Delegated Authority Report”, prepared by Brent’s Property Services team. Addressed to the Operational Director (Property and Assets), it includes the claim:

 

‘The Borough Solicitor has confirmed that pursuant to the Council’s New Constitution Part 4, paragraph 4.3 you have the delegated authority to approve of this letting.’

 

[The Borough Solicitor? – Were they using a very old template?] I have yet to receive the supporting evidence for that claim, so cannot comment yet on whether the approval of the lease extension was valid. I would mention, however, that the section of Brent’s Constitution included in the Report to justify that authority begins with the words: ‘Only the Strategic Director Resources may acquire or dispose of an interest in land or buildings’!

 

The Deed of Variation itself raised the biggest concern, particularly one new clause which it added to the terms of the original lease. I apologise for the poor quality of this copy of it, but this is the best I could prepare from the document supplied to me:

 

The new clause 10.3 in the Bobby Moore Bridge advertising lease.

 

The “Tile Mural” that this clause applies to is ‘the 9.4 metre tile football mural on the east side of the walls under the Bridge’. In other words, the “footballers” mural that was supposed to be put back on permanent public display in 2019! Yet here in an agreement entered into by Brent Council they are saying that ‘the Tenant’ (Quintain’s Wembley Park Ltd subsidiary) is entitled to cover it up, on many “event days” during the year, up until August 2024.

 

I have written to Carolyn Downs, and Brent’s Chief Legal Officer, to tell them that this clause in the lease is unlawful.

 

‘It purports to entitle the Tenant to cover 'the Tile Mural' on a substantial number of days of each year. 

 

However, on 28 November 2019, when the Deed was signed, it was already the case that the Tenant's advertising consent did not include consent to cover that "Footballers" mural scene with advertisements. That clause is therefore invalid or void, because it purports to give an entitlement which at the time was, and still is, unlawful. 

 

 

Alternatively, if that clause is considered valid, it is inoperable, because the Tenant does not have the Necessary Consent, required by the lease, to cover that mural with advertisements.

 

 

This is a legal matter which needs to be resolved now, before the resumption of events at Wembley Stadium which may lead Quintain / Wembley Park Ltd to unlawfully arrange for advertising which covers that mural, in the false belief that the lease entitles them to do so.’

 

I will ask Martin to include my “legal argument” document at the end of this article, if possible, so that it is in the public domain and anyone can read, and refer to it, if they wish to do so. If you are studying law, you might like to use it as a practical exercise, to see what you think of the merits of Brent’s case and my answer to it. If you do that, please feel free to give your “legal opinion” as a comment below!

 

I have issued my challenge to Brent over this issue (politely and respectfully, of course):

 

‘I would ask you, please, to ensure that the position I have set out in the attached document is examined promptly by the Council's legal officers; and that if I am wrong, they explain to me why that is so. 

 

If I am correct, as I strongly believe that I am, then they should acknowledge this, and take action to ensure that Quintain / Wembley Park Ltd is informed that they are NOT entitled to display advertisements covering the "Footballers" mural on the east wall of the Bobby Moore Bridge subway.’

 

One positive variation of the lease, introduced by the November 2019 Deed, was clause 10.4. This dealt with the “Tiling on East Wall” of Olympic Way, the three mural scenes showing American Football, Rugby League and Ice Hockey which were “revealed” for a few weeks in January and February 2020. It gave ‘the Landlord’ (Brent Council) the right to request that these be revealed (that is, put back on public display) for up to 21 days each calendar year.

 

The East Wall tile murals at Olympic Way, February 2020. [Photo by Mark Price]

 

I have written to ask whether Brent has made a request for these mural scenes to be “revealed” for three weeks during 2021, and if so, between which dates. You can be sure that if I get news of them being on public display, I will let you know!

 

For the moment, though, I want to make sure that the one mural scene our efforts over the past three years have managed to get put back on permanent public display, is not unlawfully covered up. And unlawfully covered up by a deal that was concealed from public scrutiny.

Philip Grant.

 

The Legal Argument (Click bottom right for full page version) 

Northwick Park Pavilion Covid19 Test Centre opened today - for those with symptoms

A new walk-through coronavirus testing facility has opened for those with symptoms to book appointments at Northwick Park Pavilion in Brent, as part of the Government’s UK-wide drive to continue to improve the accessibility of coronavirus testing for local communities.

 

Testing at this site is only available for those with coronavirus symptoms – a high temperature, a new continuous cough, or a loss or change to your sense of smell or taste. Anyone with one or more of these symptoms should book a test at nhs.uk/coronavirus or by calling 119. The government is committed to continue expanding the capacity of the network of UK test sites and laboratories to make it even easier to get tested and reduce the time it takes to receive test results.

 

The new site is situated so it is easily accessible without a car. Those being tested will be required to follow public health measures, including social distancing, not travelling by taxi or public transport, practicing good personal hygiene and wearing a face covering throughout, including while travelling to and from the testing centre. 

 

Anyone attending an appointment at a walk-through test site will be provided with guidance on getting to and from the test site safely, with additional support for vulnerable groups and people with disabilities.

 

Testing at the new site started today, Tuesday 9 February, with appointments made available each day.