IN a historic crime a new report paves the way for the sell-off of England’s Specialist Health Services.
Since the passage of the Health and Social Care Act in March the coalition government have rapidly moved to implement it by contracting out swathes of community care services to private companies, and crystallised plans to run down, franchise out and sell off NHS hospitals.
Yesterday’s bombshell was the publication of a new report defining all of England’s most specialised medical services, in a way that facilitates their packaging for outsourcing and/or sell off by the NHS commissioning board (NCB).
It is called ‘Clinical Advisory Group for Prescribed Services Final Recommendations.’
The Health Act gives the NCB the job of commissioning specialised care. These are services for the treatment of rarer health conditions such as services for; cystic fibrosis, complex spinal surgery, burns, radiotherapy. (see full list at the end)
Under the NHS these were called Specialised Regional Services. Generally they provide expensive and expert care services or facilities for catchments areas of over one million population.
They also include others such as care for prisoners and members of the armed forces.
The more localised services, in hospitals and the community, of the more common every day conditions are to be commissioned by the Clinical Commissioning Groups (CCGs).
It becomes apparent that a special committee ‘The Clinical Advisory Group’ or CAG was set up around the time of the White Paper ‘Equity and Excellence Liberating the NHS’ by Andrew Lansley, former health secretary in July 2010. They discussed their report with Ministers in December 2011.
The chairman of CAG, Dr Kathy McLean describes the report as a ‘massive task’. A committee was drawn from handpicked health service managers, specialist doctors, commissioning GPs and private providers from all over the country.
Sixty Clinical Reference Groups (CRGs) consisting of doctors, commissioners, public health colleagues and patients contributed, chaired by leading clinicians in their field. The cost of this massive effort and the names of the participants are not given.
Their task was to list and define all of the existing specialist services and package them up for contracting out by the NCB to foundation trusts or private providers on the market.
In order to do this, McLean explains that they looked at the service in terms of four criteria, a) the number of patients who required that service or facility b) the cost of providing these c) the number of persons able to provide these and d) the financial implications for CCGs if they were required to provide them.
This then was a massive marketing exercise. They have divided up the services into contractable pieces with a detailed description of each, and labelled them with clinical codes for sale, so that the “activity” can be commissioned.
This labour is on a par with the work of Lord Darzi’s committee in 2007 who defined and labelled every clinical operation and procedure into an HRG (Health Related Group) so that a price for it could be decided for setting the Payments by Results tariff. It resulted in huge tables of health procedures as commodities.
The CAG has achieved the same huge compilation of commodity definitions for specialist services. As the report says ‘The Clinical Reference Groups were established to support the transition of specialised services commissioning from the current arrangements to the NCB. The CRGs primary role is to develop the products of specialised services commissioning for example service specifications and policies.’
They did run into a few grey areas, because the NHS as founded was based on the provision for clinical need and many services are linked with related ones for the benefit of the patient. This made it difficult to separate out discrete services for sale.
They delicately explain ‘However the definitions were written for a different purpose. Where services are part of a wider pathway the definition may not set out precise limits on the elements of the service to be defined as specialised. We were struck by the difficulties which arise when an attempt is made to translate the consensus definition into contractual terms. Consequently, some of the (current) definitions, if used to prescribe a service, would not enable separate and direct commissioning by the NCB.’
They also flag up ‘boundary’ problems where a patient pathway crossed between the CCG and NCB responsibility. ‘For example, our proposals recommend that general nephrology should be commissioned by CCGs but that specialist assessment for renal transplant therapy should be commissioned by the NCB. There is an identifiable risk that activity could migrate towards one or the other if the criteria for referral to such a clinic were not clearly laid out.’
It is obvious that patient’s conditions and the care that they need does not fit into tight discrete packages. Every patient is different. The stage is being set for constant wrangling between the CCGs and the NCB as to who is responsible for contracting for and paying for the patient’s ongoing treatment.
The implications of this report are enormous. What it means, as brought out by Eoin Clarke and his researchers who flagged up the publication of this report on his blogsite, is that specialist services could be contracted out or sold off to large multinational corporations on a national scale, as they are being nationally commissioned by a national board.
The Tory coalition, is opening up the whole of specialist healthcare in Britain to be contracted out or sold off to multinational corporations, which could achieve national monopolies in the provision of any of the following;
Dental services of a prescribed description;
Services or facilities for members of the armed forces
Services or facilities for persons who are detained in a prison
Specialist Cancer Services
Radiotherapy services
Positron Emission Tomography
Blood and Marrow
Transplantation Services
Specialist Services for Haemophilia
Fetal Medicine Services
Maternal Medicine
Specialist Services to support patients with complex physical disabilities
Spinal Cord Injury Services
Specialist Rehabilitation
Services for patients with Highly Complex Needs
Adult Specialist Neurosciences Services
Specialist Burn Care Services
Cystic Fibrosis Services
Adult Specialist Renal Services
Adult Specialist Intestinal Failure Services
Adult Specialist Cardiac Services
Adult Congenital Heart Disease Services
Adult Specialist Pulmonary Hypertension Services
Adult Specialist Services for patients infected with HIV
Cleft Lip and Palate Services
Specialist Immunology Services for patients with deficient immune systems
Highly Specialist Allergy Services
Highly Specialist Services for adults with infectious diseases
Specialist Services for children and young people with infectious diseases
Specialist Services for complex liver, biliary and pancreatic diseases in adults
Specialist Genetic Services
Adult Specialist Eating Disorder Services
Adult Secure Mental Health Services
Specialist Mental Health Services for Deaf Adults
Gender Identity Disorder Services
Specialist Perinatal Mental Health Services
Complex and/or refractory disorder service
Specialised Services for Asperger Syndrome and Autism Spectrum Disorder
Specialist Services for Severe Personality Disorder in Adults
Neuropsychiatry Services
Tier 4 Child and Adolescent Mental Health services
Highly Specialist Palliative Care Services for Children and Young People
Highly Specialist Pain Management Services for children and young people
Specialist Paediatric Anaesthesia
Specialist Cancer Services for children and young people
Paediatric Cardiac Services
Specialist Dentistry Services for Children
Specialist Ear, Nose and Throat Services
Specialist Endocrinology and Diabetes Services
Specialist Gastroenterology, Hepatology and Nutritional Support Services
Specialist Gynaecology Services for Children
Specialist Haematology Services for children
Specialist Paediatric Intensive Care Services
Specialist Paediatric Mental Health
Specialist Neonatal Care Services
Specialist Neuroscience Services for children
Specialist Ophthalmology Services for Children
Specialist Paediatric Oral and Maxillofacial Surgery Services
Specialist Orthopaedic Surgery Services for Children
Specialist Plastic Surgery Services for Children
Paediatric and Perinatal Post Mortem Services
Specialist Renal Services for children
Specialist Respiratory Services for children
Specialist Rheumatology
Services for children
Specialist Surgery for children
Specialist Urology Services for Children
Highly Specialist Dermatology Services
Adult Highly Specialist Rheumatology Services
Adult Specialist Endocrinology Services
Hyperbaric Oxygen Treatment Services
Adult Highly Specialist Respiratory Services
Adult Thoracic Surgery Services
Adult Specialist Vascular Services
Adult Highly Specialist Pain Management Services
Cochlear Implantation Services
Bone Anchored Hearing Aid Services
Auditory Brainstem Implantation Service
Middle Ear Implantable Hearing Aid Services
Other Specialised Ear Surgery
Highly Specialist Colorectal Surgery Services
Adult Specialist Orthopaedic Services
Major Trauma Services
Specialist Morbid Obesity Services
Highly Specialist Metabolic Disorder Services
Adult Specialist Ophthalmology Services
Specialist Haemoglobinopathy Services
This report heralds the privatisation of the most complex and specialist healthcare services in Britain.
In 64 years the NHS has developed a geographical spread of highly skilled clinicians in these specialty services which has taken years of education and training. These tremendous and historic resources are about to be sold off and represents one of the biggest brain-drains of all time.
It is obvious with the £20bn to £50bn of cuts planned for the next period, that specialist care for ordinary patients is to be reduced, then denied and then charged for. Private monopolies will feel no obligation to provide for need if not given cash up front.
There is only one way to meet this threat, and that is to redouble the fight to mobilise the whole strength of the trade unions in industrial action to bring down this coalition government and maintain and further develop public ownership and provision of health care under a workers government.
Nothing less can preserve these very complex and necessary services for the people of Britain.