LESS ACCOUNTABILITY?

Patients and staff shut out of NHS transformation plans, says thinktank (The Guardian: 14 November 2016)

NHS plans that could lead to hospital and A&E closures have been kept secret from the public and barely involved frontline staff, a thinktank has said.

NHS England has told local health leaders not to reveal the plans to the public or the media until they are finalised and have been approved by their own officials first, according to published documents and a new analysis by the King’s Fund.

The national body even told local managers to refuse applications from the media or the public to see the proposals under the Freedom of Information Act.

Local managers accused NHS England of being intent on “managing the narrative” about the plans.

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NHS England and some health experts say the changes will improve patient care and are necessary to fulfil the plan of the health secretary, Jeremy Hunt, for full seven-day services. Opponents argue they are just a way of cutting services.

Some councils have objected so strongly to the lack of public involvement that they have ignored NHS England’s demand to keep the documents private until a later stage and have published them on their websites.

The report from the King’s Fund, based on a review of plans and interviews with local managers, says NHS England set very tight timescales, which is partly to blame for patients and doctors being shut out.

Expensive management consultants have been brought in but clinical teams and GPs have often been only “weakly engaged in the process”, it says.

The report says: “It is clear from our research that STPs have been developed at significant speed and without the meaningful involvement of frontline staff or the patients they serve … Patients and the public have been largely absent from the STP process so far.”

One local manager said of the lack of public involvement: “I’ve been in meetings where I’ve felt a little bit like, you know, where are the real people in this?” Another described the secrecy demanded by NHS England as “ludicrous”....read more

 

NHS: Rules preventing tax-avoiding companies from securing health care contracts scrapped (The Independent: 8 February 2016)

Health service rules that prevent tax-avoiding private companies from securing NHS contracts are being scrapped - for fear they “discriminate” against firms with Google-style arrangements.

NHS managers trying to ensure that private contractors do not use tax avoidance strategies are having their efforts overturned due to nervousness about litigation by global corporations, The Independent can reveal. 

In recent years many Clinical Commissioning Groups (CCGs) – the bodies which issue contracts for local NHS services – have tried to block companies from bidding for work if they use convoluted tax structures.

But Bristol CCG is now in the process of striking out the rule, after it was questioned during the recent tender to supply children’s community services. Lawyers feared that the rule discriminates against healthcare companies who are legally avoiding tax - allowing them to sue the NHS if they do not win the contract. 

The Bristol tender included a bid from Virgin Care, whose parent company is based in the tax-haven British Virgin Islands...read more

NHS England to commission probe into £800m contract collapse (HSJ: 22 December 2015)

NHS England is to commission an investigation into the dramatic collapse of an £800m flagship NHS contract in Cambridgeshire, HSJ has learned.

The investigation will cover the “circumstances leading up to the termination of the contract between Cambridgeshire and Peterborough Clinical Commissioning Group and UnitingCare Partnership”, a statement by health minister Lord Prior said.

The investigation will also scrutinise the role played by the Strategic Projects Team, the NHS’s internal commercial advisors, which advised on the contract and has been involved in a number of other significant and controversial procurements.

The news was disclosed following a parliamentary question from Labour’s deputy leader of the opposition in the House of Lords, Lord Hunt. His question specifically asked how the Strategic Projects Team would “be held to account” for its role in what unions called a “calamitous” affair.

Lord Hunt’s question read: “To ask Her Majesty’s Government how the NHS Strategic Projects Team is to be held to account for the advice it gave to the Cambridgeshire and Peterborough CCG, and to the NHS Commissioning Board, on the contract for older people’s services in Cambridge and Peterborough.”

Minister for NHS productivity Lord Prior’s written answer said: “NHS England advises that it will be commissioning an investigation into the circumstances leading up to the termination of the contract between Cambridgeshire and Peterborough CCG and UnitingCare Partnership to deliver urgent care for the over 65s and adult community services.

“This will include the role of the Strategic Projects Team. NHS England is also considering how similar contracts will be managed and assured in the future.”

The Strategic Projects Team, which has a mission statement of driving “change from within”, carries out board meetings in private. NHS England has refused to release the team’s board papers. It is hosted by the Greater East Midlands Commissioning Support Unit.

The team has advised on procurements including the franchising of Hinchingbrooke Health Care Trust; the East of England pathology services reconfiguration, and the £350m national PET-CT imaging services re-procurement project. 

 

Government accused of trying to 'cover up' scale of looming NHS winter crisis (Independent: 6 December 2015)

Health service confirms scaled-back bulletins will no longer include A&E waiting times or cancelled-operation figures

Patients and health experts have accused the Government of trying to “cover up” the scale of a looming winter health crisis by blocking the publication of key waiting-time figures. In a controversial move, made as MPs debated authorising bombing raids in Syria, the NHS announced it was dramatically scaling back the number of benchmark tests included in its weekly bulletins – now to be published monthly – which are supposed to give a snapshot of the state of the health service. 

NHS England has confirmed that the updates, due to start on 11 December, will no longer include figures on A&E waiting times, ambulance delays outside hospitals or last-minute cancellation of operations. The number of patients left on trolleys for longer than four hours will also be taken off the updates. The move comes after ministers admitted that the official reporting period for the winter had been shortened by a month – further limiting what the public can find out about growing problems in the NHS.

Over the past two years, “winter” ran from the start of November until the end of March. However, in response to a parliamentary question, Public Health minister Jane Ellison admitted that the reporting period this year will end a month earlier. The move comes amid growing government fears that this winter crisis to set to be worse than at any time in the past five years because of staff shortages caused by a clampdown on expensive agency staff.....see more

 

Arriva may face SFO fraud inquiry over NHS deal (The Independent: 8 November 2015)

Ministers have hinted that the transport giant Arriva could be subjected to a Serious Fraud Office inquiry after it inflated figures on an NHS contract. 

In September, Arriva self-reported that figures were wrong on a deal to provide non-emergency patient transport in Greater Manchester. This earned the group £1.5m extra in incentive fees for good performance – despite hundreds of complaints about its work last year. The money has been handed back to the area’s 12 clinical commissioning groups. 

Arriva’s Transport Solutions division beat the North West ambulance service to the current contract, stoking fears that the NHS is gradually being privatised...see more 

 

Why does Downing Street want details of all your appointments with your doctor? (Our NHS: 21 July 2015)

The government is trying to get its hands on the personal details of millions of patients’ GP appointments.

The government has written to the companies who provide IT for GPs to ask them to help it obtain the date, time and duration of each appointment for 18 million patients, including the “reason” for each appointment, and the gender, year of birth and most of the postcode for each patient. It wants the details for every appointment in the last two years, as well as all appointments going forward.

The request came in a letter from one of Cameron’s key officials,Tracey Grainger, Programme Director for Prime Minister’s Challenge Fund Digital Team, who claimed it was backed by “the most senior levels of government including ministers”.

The letter, which OurNHS has seen, insists on considerable haste, stating that "there is an urgent need within short delivery timescales" and that the extraction of the patient information “needs to be in place by September 2015”.

 

NHS details released against patients' wishes, admits data body (The Guardian: 6 June 2015)

The body responsible for releasing NHS patient data to organisations has admitted information about patients has been shared against their wishes, it has emerged.

Requests by up to 700,000 patients for details from their records not to be passed on, registered during preparations for the creation of a giant medical database, have not been met.

But the Health and Social Care Information Centre (HSCIC) told MPs that it “does not currently have the resources or processes to handle such a significant level of objection” and it also encountered technical issues over logging the preferences.

Patients registered their objections during the development of the controversial care data system but the plans were shelved in March 2014.

 

NHS struggling to monitor the safety and efficacy of its services outsourced to private providers (The Independent: 19 April 2015)

The NHS is struggling to monitor and assess the safety and efficacy of services it has outsourced to private providers, according to a report published this week.

Local clinical commissioning groups (CCGs) now spend 16 per cent of their care budget in the private sector and need to manage, monitor and enforce some 15,000 contracts with private providers.

A growing number of the contracts are with large multinationals and companies backed by private equity, of which only seven have been terminated due to failings, a report by the independent think-tank Centre for Health and the Public Interest (CHPI) discovered.

It said the abuse at Winterbourne View Hospital, which was run by Castlebeck Care until it went into administration, and Serco’s out-of-hours primary care contract in Cornwall, which was taken back by GPs in February, were just some of the high-profile cases where the NHS failed to manage contracts with private providers effectively.

 

Jeremy Hunt under fire for failure to publish critical NHS report (The Independent: 8 March 2015)

Health Secretary Jeremy Hunt has been accused of undermining his own plan for a “transparency revolution” in the NHS by refusing to publish a report said to be critical of the Government's handling of the health service.

The report by Conservative peer Stuart Rose was submitted to the Government in December and was due to be made public before the general election in May.

However, the Department of Health said publication has been delayed because the Rose review’s remit had been expanded and “further work is required”. The findings of another NHS report also needed to be taken into account, it added.

According to the Financial Times Lord Rose, a former chief executive of Marks & Spencer, found the management of the NHS to be “totally shocking”. He is also reported to have concluded that major changes to the way the NHS is run, brought in by Mr Hunt’s predecessor Andrew Lansley, had made things worse.

 

The NHS under the Tories - more bureaucracy, less accountability (Daily Mirror: 6 February 2015)

The coalition has failed spectacularly in its plan to simplify and make the NHS more accountable, a new report from The King's Fund has found.

The Tories were meant to simplify the NHS by getting rid of layers of bureaucracy, and promised to "stop top-down reorganisation of the NHS".

The other issue is that, along with adding layers of bureaucracy, one of the outcomes of the Tories fiddling with the organisational structure is that there's now a lack of accountability. For more information see The NHS Under the Coalition: Part 1 Reform

Archive of earlier stories 

see also: 
 
CONFLICTS OF INTERESTS
SEC OF STATE FOR HEALTH
 

  

Reports on the NHS changes

The NHS under the Coalition: Part 1 NHS Reform - The Kings Fund, February 2015

Accountability in the NHS: Implications of the government’s health reform programme, Jo Maybin, Rachael Addicott, Anna Dixon and John Storey, The King's Fund 2011

Parliamentary Debate on Accountabililty and Transparency in the NHS (March 2013)

NALM briefing on Health Watch

See the Health Act on public involvement

 

News:

Lords warn on ministerial accountability in NHS reforms. (The Guardian, 20th December 2011)

The coalition government's health bill will dilute accountability to parliament and the courts and should be amended to address serious constitutional issues that remain, a Lords committee has warned.

Proper accountability and the importance of data post-Francis Peter Smith (The Health Foundation, May 2013)

Recommendations of the Francis Report

 

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