……..we are in the process of updating / clarifying / renaming this page and contents…..watch this space…..

STP’s, ACO’s, cuts, closures, “wholly-owned subsidiary companies”…….

>>> Recent developments

NHS survey now closed: Friday 8th January 2021

NHS England

Survey About Integrated Care Systems
NHS England are conducting a survey about Integrated Care Systems (ICSs).  If you already know about ICSs, you may want to go straight to these links. The Integrating Care Document link is here  and the Survey link is here
If you are unfamiliar with ICSs a good starting point is this article and there are many more links to articles and KONPNE briefings on our website  or  at “The Lowdown.” 
In short, NHS England (NHSE) is consulting on their latest plans for ‘integrating care’, including changes to legislation. The proposals include a top-down re-organisation of the NHS in England under tight financial control from the centre and with even less public accountability. The result will be massive new opportunities for private companies through the ‘Health Systems Support Framework’ (HSSF). ICSs will be statutory NHS bodies and, as such, limited in their ability to work in partnership with others, such as with local authorities in addressing health inequalities.
The main objections we have to ICSs is the lack of democracy and accountability (there will be no scrutiny by our local councils and it will be much more difficult to oppose any decisions to ration NHS services or deny access to care) and increased privatisation as ICSs will be instrumental in opening up the NHS to very large-scale (ICS-size) takeovers by multinational corporations and institutions.
Some very useful links from national KONP:
Model responses from national KONP:  KONP-ICS-consultation-model-responses-2021-01-03 (2)
Summary briefing from national KONP: KONP-ICS-summary-briefing-2021-01-03
KONP objections to legislative changes: KONP-ICS-legislation-proposals-responses-2021-01-03

>>> Recent articles and links:

This Spring we are facing the introduction of parliamentary legislation designed to confirm what are known as ‘Integrated Care Systems’ as “NEW NHS BODIES”. These will divide up the NHS into approx. 42 pots of money with limited ‘population health budgets’ designed to find more ‘efficiency savings’ or as we know it – CUTS.
Click here and read on – American Accountable Care (“Integrated Care Systems” in UK) has no place in our NHS. Please take a few minutes to explore the following link – it clarifies the situation we face in 2021….
999 call for the NHS (7th January 2021)  We say NO! to proposed NHS legislation that would restrict access to care and profit global companies
The Lowdown (8th January 2021)   Councils concern about NHS shakeup
Chronicle (17th December 2020)  City leaders back groundbreaking new partnership to transform health and social care services
CK 999 Call for the NHS (14th December 2020)    US companies poised to run NHS following proposed legislation
The Lowdown (6th December 2020)    NHS England pushes for “integration” … but not as we know it
KONP (10th December 2020)   Dangerous NHS restructuring to go ahead despite Covid
The Guardian: Years of underfunding leave NHS ‘woefully short’ for Covid second wave   (5th November 2020)
CCG mergers > ICSs: The Lowdown (September 28th 2020)
Who’s cashing in on ICS’s?    The Lowdown (October 12th 2020)

>>> Cuts and closures: Sustainability and Transformation Plans (STP’s)

The NHS is underfunded. The Government says that we can’t afford more, but we know that this underfunding is a political choice – along with the subsequent cuts, closures, lengthening waiting lists and demoralisation of staff.
The reality is that the UK, the worlds sixth largest economy, chooses to spend significantly less per head on health than Germany or France – and less than half what is spent in the US or Switzerland.
>> Patients4NHS   What is happening to the NHS – A Guide for Patients and Public
>> National KONP   STP’s: What you need to know
>> Carol Ackroyd   FAQ’s about STP’s
>> Patients4NHS  Information sheet
>> Unite the Union  Mythbusting: STP’s
>> Centre for Health and the Public Interest   STP’s: Five Key Questions for Planners  
>> London South Bank University  STP’s: How serious are the proposals? A critical review
>> The Centre for Health and the Pubic Interest (January 2017)  – article by John Lister, Health Campaigns Together   STP’s: A Critical Assessment
>> The Centre for Health and the Public Interest (October 2017)   Unaccountable Policy Making for the NHS in England
>> Public Matters (Feb 2018)  Will the written evidence to the Health Select Committee bring about the end of the Sustainability and Transformation Plans?
>> Article on the Health and Social Care Act 2012 (June 2013)  Tritter and Koivusalo – Undermining patient and public engagement and limiting its impact – the consequences of the HSC Act 2012 on collective patient and public involvement 
>> Guardian article on Health and Social Care Act 2012  (March 2013)  Youssef El-Gingihy – Health Act means the death of the NHS as we know it
October 2019 KONPNE Briefing Papers (for public use, plus copies sent to all Councillors in NE)

2019 KONPNE briefing - ACO and ICS-page0001 (5)

Accountable Care Organisations and Integrated Care Systems        2019 KONPNE briefing – ACO and ICS

2019 KONPNE briefing - We Need To Be Worried-page0001 (3)

We need to be worried about the NHS Long Term Plan, Integrated Care Systems and Primary Care Networks          2019 KONPNE briefing – We Need To Be Worried
Local and national NHS documentation relating to STP’s 
>> North East and North Cumbria Integrated Care System Strategic Five-Year Plan 2019  (Nov 2019) NENC ICS Five Year Plan – 15.11.19
>> Draft Northumberland, Tyne, Wear and North Durham Sustainability and Transformation Plan (Nov 2016)  Full document: NTWND-STP-final-submission-combined   
>> April 2017 Guidance from Newcastle City Council’s “Wellbeing for Life Board” about the “Communities and Neighbourhood model” is here  This paper proposes ways in which the STP may fit within organisational structures.
>> NHS England guidance on engagement and consultation re STP’s is here: engag-local-people-stps
>> NHS England guidance on operational planning is here: NHS-operational-planning-guidance-201617-201819 (1)

>>> Privatisation of the NHS: Accountable Care Systems (ACS’s), Accountable Care Organisations (ACO’s), Integrated Care Systems (ICS)

The growing privatisation of our NHS includes awarding large commercial contracts  for hospital, community and general practice to private businesses and corporations such as Virgin Care, Care UK, and HCA. Services such as ambulance, laboratory, cleaning and IT are also outsourced. The competition for contracts leads to aggressive cost-cutting, with loss of services and deskilled, poorly paid and demotivated staff.
Now, Government plans for “Accountable Care Organisations” risk wholesale NHS privatisation by tendering a single massive contract to run all of the hospitals, community services and, sometimes, social care services in one geographical region. Bidders are likely to include US healthcare giants and, equally deadly, private – public partnerships between finance corporates and NHS Trusts. The Government claims that these commercial contracts are needed for the “joined up” services that we all want. In reality, they will destroy our NHS. We need to restore our NHS as a publicly planned, run and publicly owned NATIONAL service, funded through taxation
>> Comprehensive briefing paper on ACO’s from national KONP:
The online summary and link to the full document, the summary pdf document  and the full pdf document
>> Jon Ashworth identifies serious concerns re STP’s and ACO’s: Changes regarding healthcare provision must be debated and voted in Parliament      New Statesman 8.12.17 
>> Legal Challenge to the ACO’s number 1: 999 Call for the NHS is here
Working with public law firm LEIGH DAY, 999 Call for the NHS believe that the ACO contract is unlawful under current NHS legislation, on the grounds that the contract does not link payment to the number of patients treated and/or the complexity of the medical treatment provided. It fails to ensure that there would be sufficient money to meet the cost of delivering NHS services to the required quality standard. 
>> Legal challenge to the ACO’, number 2: Judicial Review for the NHS (JR4NHS) is here
 Working with public law firm LEIGH DAY, the JR4NHS team believe that  ACOs would fundamentally change the NHS and many private businesses could profit from this radical reorganisation of health and social services. These private businesses would have control over the allocation of NHS and taxpayers’ money. Their accountability for spending it and their obligations to the public would be under commercial contracts, not statutes. This is not in the public interest. It is also against the public interest that ACO’s are being introduced by stealth, without proper public consultation and without full Parliamentary scrutiny. 
>> House of Commons briefing paper on ACO’s
>> Commons Health & Social Care Select Committee on ACOs  Oral evidence on dangers for the NHS of Accountable Care Systems and Organisations  (click on the link at the bottom of this page to watch the proceedings)
>> 999 Call for the NHS  – Is Accountable Care on hold? (March 2018)  999 Rough Guide to Accountable Care
>> New Internationalist – Jo Land (April 2018) Why neo-liberal institutions are pushing “Accountable Care” in health
>> Parliament debates e-petition on NHS Privatisation (April 2018)
Stop the privatisation of NHS services
We call for a ban on the outsourcing (privatisation) of NHS services, and stop the renewal of any outsourcing contracts already signed. Companies should not be profiteering from NHS contracts, when every pound of NHS budgets is desperately needed for more doctors and nurses, and to pay them more.
Research by Bain & Company published by the Financial Times in January 2017, found that private-sector companies had been invited to bid for 14 per cent more NHS contracts in the 12 months to August 2016 than just a year previously. In March 2017 the Financial Times also reported of the extra £2bn given to the NHS in 2014 to try and bolster NHS services, according to data analysis carried out by the Health Foundation, an independent charity, only about half this extra money was spent in the NHS.
Watch the debate: https://parliamentlive.tv/Event/Index/dd85df77-1e1d-4f1b-bb9f-30a6f5e06a98
Read the transcript: https://hansard.parliament.uk/commons/2018-04-23/debates/A43878B7-E1E8-4205-A7D2-6624BCF0E403/PrivatisationOfNHSServices
The petition: https://petition.parliament.uk/petitions/205106
>>> KONP analysis (June 2018) of Select Committee Report on Integrated Care and ACOs 
>>> KONP report and info (Oct 2018) re ICP Consultation (incl KONP video on ICP’s)   https://keepournhspublic.com/privatisation/icps-what-are-they/
>>> National KONP response to the ICP Consultation (Oct 2018) National KONP response to ICP consultation Oct 2018
>>> Dr Hutchinson, Prof Pollock, Prof Richards, Dr Winyard  respond to ICP proposals (Oct 2018):  Pollock, Hutchinson, Richards, Winyard ICP Consultation Response 2018
and an overview (Oct 2018) is here: A message from Professor Allyson Pollock and colleagues
>>> Presentation to North East Joint STP Health Scrutiny Committee by Amanda Hume, Executive Lead for Transformation and Strategic Commissioning (Jan 2019) – click on item 5  An Aspiring Integrated Care System
Local and national NHS documentation relating to ACO’s
>> NHS England guidance on contracting for ACO’s (August 2017)  – “Integrating care – contracting for accountable models”
>> The NHS England webpage which provides links to associated operational documents is here
NHS Long Term Plan (January 2019)
>> Response from national KONP (January 2019) – “NHS Long Term Plan – unfunded, undemocratic, unfair, unsafe”
>> Commentary article from Our NHS (January 2019) – “The NHS Long Term Plan, Prevention, and a Century of Promises”
>> Article in the Independent, Dr Youssef El-Gingihy (January 2019) – “The NHS 10-year plan has cleared a path for total privatisation of our health service”
>> Article from 999 Call for the NHS (February 2019) –  “Massive North East and North Cumbria ICS to go live in the Spring”
>> and another great article from 999 (February 2019) – “What changes will patients notice when the NHS is run by Integrated Care Systems and Providers?”
>> Centre for Health and the Public Interest (January 2019) – “Is this the way the future’s meant to feel? The NHS Long Term Plan and the future of health and social care in England”
>> Report on the local NHS position in the NE (January 2019)“A shadow Aspiring Integrated Care System”  click on item 5
>> KONPNE briefing leaflet on ACO and ICS(January 2019) – konpbriefingonacoandics-konpne2019
>> KONPNE briefing leaflet – questions to ask in Council (January 2019) – konpquestionsreics-konpne2019
>> National KONP flyer regarding long Term Plan (January 2019) – konplongtermplan
Parliamentary reports
>> Parliamentary report and guidance on the Effectiveness of Local Authority Overview and Scrutiny Committees   (December 2017)
>>> and the Governments response to the report on the Effectiveness of Local Authority Overview and Scrutiny Committees (March 2018) – this recommends actively encouraging public participation
>> North East – Privatisation in 111, On Call and Urgent Care; Northern Doctors -> Vocare -> Totally  www.vocare.org.uk/docs/Vocare%20RNS%20announcement.pdf
>> National report from The Centre for Health and the Public Interest; this report was published in April 2015, but still provides some important information and pointers for future action  
The Contracting NHS: Can the NHS Handle the Outsourcing of Clinical Services?

>>> Backdoor privatisation of the NHS: “Wholly-owned Subsidiary Companies” (SubCo’s) / “Arms-Length Companies

“A wholly owned subsidiary is an organisation set up at arm’s length but still owned by the trust. It means that those services currently provided in-house will be provided by a separate company that will employ staff who currently work for the NHS.
Trusts claim that money will be saved by exploiting a tax loophole, but the major savings will come from employing new staff on non-NHS terms and conditions with no access to the NHS Pension Scheme.
….this is a form of backdoor privatisation, with direct consequences for healthcare staff and potentially damaging ramifications for the NHS.”
Excerpt from Unison  Wholly Owned Subsidiaries in the NHS
>> In the North East – NTW NHS Trust (March 2017)  Proposal to establish an NTW Subsidiary Company
>> Expanatory article by Caroline Molloy, Our NHS (February 2018) – refers to NTW and Gateshead  Are cash-strapped hospitals walking into a trap that could cost the NHS its family silver?
>> NHS Support Federation – refers to NE Trusts  Back door privatisation: the rise of the spin-off company in the NHS
>> KONP briefing article (March 2018)  No to Subsidiary Companies in the NHS
>> Links from Unison   NHS Subsidiary Companies
>> Statement (March 2018) – plus see useful list of outstanding questions at the end of the document  Gloucestershire NHS “SubCo” approved
>> Report from NHS Support Federation  The Rise of the Spin-Off Company in the NHS
>> Situation in Wigan (February 2018)  Unison report
>> Liz Twist Early Day Motion (January 2018)  EDM 802

>>> Sale of NHS land and buildings

The 2017 Naylor Report proposes selling off NHS assets. This latest Public / Private Partnership scam involves the government working with property developers to force a “fire sale” of valuable NHS buildings and sites. These developers will then build “community hubs” and lease them back to the NHS, making massive profits. These sales are going ahead without planning for future need and with no public consultation.
Please click on the website NHS Property Services for details of NHS building and land currently under offer / recently sold.
Once the land and buildings have gone, it makes privatisation all the more easy…..
Article from Labour Party (Sept 2018)  Rise in NHS Land Sales

>>> More leaflets, books and resources:

can be found on our website Resources page