[14 November 2016]
STPs – sustainability & transformation plans – are the health and social care regional blueprints that follow Simon Stevens’ roadmap for the NHS. They hide in disguise the true agenda for health and social care of this government: massive cuts to services and creation of chances for private health organisations to cash in on this latest NHS disorganisation. Keep Our NHS Public calls for all the details of these plans to be made public immediately, nationwide. Public consultation should not have been delayed to avoid the challenge that the plans further the break-up of our NHS.
The King’s Fund have said that plans for massive reorganization of the NHS and social care in England, STPs, were hatched in private on the direct instruction of NHS England[1]. This comes after an edict from NHSE to all 44 STP authorities to submit their draft plans to them before even thinking of making them public so NHSE could approve the language. KONP has determined that the STPs themselves omit the most critical details and hide them away in appendices which are NOT handed out freely. How much more evidence of secrecy is needed? And how much more obvious is it that these so-called ‘consultation’ documents are nothing of the sort, but simply a shroud to hide the real agenda? Which is one of massive cuts to services, as local authorities struggle to make ends meet with rising demand, year-on-year under-funding of the NHS, and swathes of cuts to social services?
Dr Tony O’Sullivan, a retired consultant paediatrician and Co-chair of Keep Our NHS Public, said:
‘I am afraid to say that NHS England’s Medical Director Sir Bruce Keogh is once again letting down the NHS with the disingenuousness of his statement: “The NHS in every part of the country needs a clear plan to take advantage of these new opportunities”.
‘These plans are not “opportunities” but contain serious threats to the NHS. The detail is in the appendices to the STP. Even where STPs have been published, these appendices still remain secret – this may require FOIs, and we know some authorities are refusing FOI requests on the grounds that they are “not in the public interest”. It is there where we will see detailed plans for cutbacks of thousands of hospital beds, hospital or A&E closures, merging of maternity units, and rationing of care.
‘Undemocratic processes rushed through secretively will deliver dangerous results. Community-based care and better health has already been undermined by large cuts to public health spending and even larger cuts to adult social care. And there is a serious dearth of evidence that even very good community care can replace significant amounts of hospital beds[2]. Yet the private sector has been primed to look for new opportunities within this major national disorganisation. An honest answer from Keogh would be to join with the King’s Fund to point to the acute risk in pushing through financially driven major changes, without the voice of public and informed clinicians; to call for a halt to this process; and to insist on proper funding of the NHS and training of sufficient staff.’
[Ends]
[1] https://www.kingsfund.org.uk/publications/stps-in-the-nhs
[2] See appendix attached.
Editors’ Notes
Keep Our NHS Public was formed in 2005 and has a broad-based, public membership. There are over 50 local and affiliated groups, plus a national association. It has the explicit aim of countering marketisation [3,4] and privatisation of the NHS by campaigning for a publicly funded, publicly provided and publicly accountable NHS, available to all on the basis of clinical need. It is opposed to cuts in service which run counter to these principles. Further details: www.keepournhspublic.com
KONP’s Campaigns and Press Officer is Alan Taman:
07870 757 309
Twitter: https://twitter.com/keepnhspublic
Facebook: Keep-Our-NHS-Public
[3] Davis, J., Lister, J. and Wrigley, D. (2015) NHS For Sale. London: Merlin Press.
Leys, C. and Player, S. (2011) The Plot Against the NHS. Pontypool: Merlin
Lister, J. (2008) The NHS After 60: For Patients or Profits? London: Middlesex University Press
Owen, D. (2014) The Health of the Nation: The NHS in Peril. York: Methuen, Chapter 4.
Player, S. (2013) ‘Ready for market’. In NHS SOS ed by Davis, J. and Tallis, R. London: Oneworld, pp.38-61.
[4] The belief that ‘competition is always best’ does not work when applied to healthcare. A comprehensive and universal health service is best funded by public donation, which has been shown to be far more efficient overall than private-insurance healthcare models
[Davis, J., Lister, J. and Wrigley, D. (2015) NHS For Sale. London: Merlin Press. Chapters 2 and 8.
Lister, J. (2013) Health Policy Reform: global health versus private profit. Libri: Faringdon.
Pollock, A. and Price, D. (2013) In NHS SOS, ed by Davis, J. and Tallis, R. Oneworld: London, 174.]
Appendix: Sources for information on community based care, Admission avoidance and integrated care
| Overview on proposition that there are alternatives that can replace hospital care |
|
NHS For Sale: Myths, Lies & Deception. Jacky Davis, John Lister, David Wrigley. 2015 pp 44-47- Are alternatives any cheaper? Do they even work? [references in book]
Monitor. Moving healthcare closer to home: a summary It is difficult to cut costs across a local health economy in the short run Although schemes can help hospitals avoid future capital spending, it is difficult for local health economies to save costs in the short run through community-based schemes. Three of the four schemes we modelled did not break even within five years. This is because: • Schemes can take up to three years to set up, recruit and become sufficiently credible to attract referrals. So providers and commissioners should not expect immediate impacts. • Even when schemes are cheaper per patient, it may be difficult for the local health economy to realise any savings. A local scheme (or schemes) will only lead to health economy-wide savings if it consistently diverts enough patients from local acute hospitals to allow them to close bed bays or wards. The cost saving is then only realised if providers and commissioners have the will to close down capacity that is freed up. In the context of rising demand for acute care, commissioners and providers will need to be entirely confident that community-based schemes can safely absorb expected extra demand before they will feel justified in closing acute capacity. However, community-based schemes will help commissioners and providers to avoid or delay future capital spending whether acute capacity is closed or not.
|
| Is there evidence for community based care reducing hospital admissions safely? |
|
David Oliver. Preventing hospital admission: we need evidence based policy rather than “policy based evidence”. BMJ September 2014; http://www.bmj.com/content/349/bmj.g5538 “In July 2014 commissioners throughout England published projections for reductions in urgent admissions to their local hospitals.1 But the size and speed of these reductions were not informed by any credible peer reviewed evidence—they rarely are. Recent reviews by the Universities of Cardiff and Bristol on admission prevention and by the health think tank the Nuffield Trust on new models of service in the community, found that the big and rapid reductions were illusory, once the findings had been peer reviewed and control data taken into account.” [other references in article] |
|
Roland M, Abel G 2012. Reducing emergency admissions: are we on the right track? BMJ 2012;345;e6017, 16 September 2012
“Most admissions come from low risk patients, and the greatest effect on |
|
http://www.biomedcentral.com/content/pdf/1744-8603-9-43.pdf Does investment in the health sector promote or inhibit economic growth?
http://www.hsj.co.uk/Journals/2014/11/18/l/q/r/HSJ141121_FRAILOLDERPEOPLE_LO-RES.pdf Commission on hospital Care for Frail Older People HSJ and Serco
|
| S Purdy. Interventions to reduce unplanned hospital admissions. 2012. A series of systematic reviews of 18000 studies and includes a very handy two page summary of evidence. http://www.bristol.ac.uk/primaryhealthcare/researchpublications/researchreports/
“Background: The overall aim of this series of systematic reviews was to evaluate the effectiveness and cost-effectiveness of interventions to reduce UHA [unplanned hospital admission]. Our primary outcome measures of interest were reduction in risk of unplanned admission or readmission to a secondary care acute hospital, for any speciality or condition. We planned to look at all controlled studies namely randomised trials (RCTs), controlled clinical trials, controlled before and after studies and interrupted time series. If applicable, we planned to look at the cost effectiveness of these interventions.” “Conclusions: This review represents one of the most comprehensive sources of evidence on interventions for unplanned hospital admissions. There was evidence that education/self-management, exercise/rehabilitation and telemedicine in selected patient populations, and specialist heart failure interventions can help reduce unplanned admissions. However, the evidence to date suggests that majority of the remaining interventions included in these reviews do not help reduce unplanned admissions in a wide range of patients. There was insufficient evidence to determine whether home visits, pay by performance schemes, A & E services and continuity of care reduce unplanned admissions.”
[See below for further extracts on individual areas reported on]
|
| Effect of targeted intervention to population ‘at risk’ of admissions |
|
http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/red_cross_research_report_final.pdf The effect of the British Red Cross ‘Support at home service” on hospital utilisation. Nuffield Trust
“We analysed data on hospital use in the six months after referral to Support at Home. The Red Cross group had a 19% higher rate of emergency admissions than the control group. Accident and emergency visits were also similarly higher. Nonemergency admissions, however, were 15% lower in the Red Cross group than in the matched control group. There was no significant difference between the two groups in terms of outpatient attendances.” [extract from executive summary]
|
| On Integrated care |
|
http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_summary/Reconfiguration-of-clinical-services-kings-fund-nov-2014.pdf The reconfiguration of clinical services: what is the evidence? Kings Fund. Candace Imison
http://www.nuffieldtrust.org.uk/sites/files/nuffield/evidence-base-for-integrated-care-251011.pdf
http://www.nets.nihr.ac.uk/__data/assets/pdf_file/0005/81266/BP-08-1210-035.pdf |
| On impact of social care |
|
David Oliver president, British Geriatrics Society, and visiting fellow, King’s Fund. We cannot keep ignoring the crisis in social care. BMJ May 2015; http://www.bmj.com/content/350/bmj.h2684
|
Tony O’Sullivan, with addition by Brian Fisher 2 October 2015
S Purdy (2012) Interventions to reduce unplanned hospital admissions which is a series of systematic reviews of 18000 studies and includes a very handy two page summary of evidence.
http://www.bristol.ac.uk/primaryhealthcare/researchpublications/researchreports/
Executive summary:
“Background: The overall aim of this series of systematic reviews was to evaluate the effectiveness and cost-effectiveness of interventions to reduce UHA [unplanned hospital admission]. Our primary outcome measures of interest were reduction in risk of unplanned admission or readmission to a secondary care acute hospital, for any speciality or condition. We planned to look at all controlled studies namely randomised trials (RCTs), controlled clinical trials, controlled before and after studies and interrupted time series. If applicable, we planned to look at the cost effectiveness of these interventions.”
“Conclusions: This review represents one of the most comprehensive sources of evidence on interventions for unplanned hospital admissions. There was evidence that education/self-management, exercise/rehabilitation and telemedicine in selected patient populations, and specialist heart failure interventions can help reduce unplanned admissions. However, the evidence to date suggests that majority of the remaining interventions included in these reviews do not help reduce unplanned admissions in a wide range of patients. There was insufficient evidence to determine whether home visits, pay by performance schemes, A & E services and continuity of care reduce unplanned admissions.”
Executive summary of findings under individual categories
Overall case management did not have any effect on UHA although we did find three positive heart failure studies in which the interventions involved specialist care from a cardiologist”
“specialist clinics for heart failure patients, which included clinic appointments and monitoring over a 12 month period reduced UHA. … There was no evidence to suggest that specialist clinics reduced UHA in asthma patients or in older people.”
Community interventions: Overall, the evidence is too limited to make definitive conclusions. However, there is a suggestion that visiting acutely at risk populations may result in less UHA e.g. failure to thrive infants, heart failure patients.
Care pathways and guidelines: There is no convincing evidence to make any firm conclusions regarding the effect of these approaches on UHA, although it is important to point out that data are limited for most conditions.
Medication review: no evidence of an effect … in older people, and on those with heart failure or asthma carried out by clinical, community or research pharmacists … the evidence was limited to two studies for asthma patients.
Education & self-management: Cochrane reviews concluded that education with self-management reduced UHA in adults with asthma, and in COPD patients but not in children with asthma. There is weak evidence for the role of education in reducing UHA in heart failure patients.
Exercise & rehabilitation: Cochrane reviews conclude that pulmonary rehabilitation is a highly effective and safe intervention to reduce UHA in patients who have recently suffered an exacerbation of COPD, exercise based cardiac rehabilitation for coronary heart disease is effective in reducing UHA in shorter term studies, therapy based rehabilitation targeted towards stroke patients living at home did not appear to improve UHA and there were limited data on the effect of fall prevention interventions
Telemedicine is implicated in reduced UHA for heart disease, diabetes, hypertension and the older people.
Vaccine programs: … the effect of influenza vaccinations on a variety of vulnerable patients. A review on asthma patients reported both asthma-related and all cause hospital admissions. No effects on admissions were reported. A review on seasonal influenza vaccination in people aged over 65 years old looked at non-RCTs. The authors concluded that the available evidence is of poor quality and provides no guidance for outcomes including UHA. A review on health workers who work with the elderly showed no effect on UHA.
Hospital at home: This was a topic covered by a recent Cochrane review of hospital at home following early discharge. Readmission rates were significantly increased for older people with a mixture of conditions allocated to hospital at home services.
We found insufficient evidence (a lack of studies) to make any conclusions on the role of finance schemes, emergency department interventions and continuity of care for the reduction of UHA.
Leave a Reply