30 Questions for the NHS inquiry
Many of these concerns are based on rumours rather than facts, but they are still genuine worries which need to be laid to rest before we can commit to changing the way the NHS and Social Care are delivered.
(Note: These are statements which have been made to me by concerned residents, not my own words)
Concerns about the case for change:
1. The statistics presented in the “case for change” are misleading. They make unrealistic assumptions about how much we can change people’s behaviour and how much money this will save through reducing illness.
2. The current system works fine, it just needs more money. We used to have lots more hospital beds in Cornwall. If we brought them back, we wouldn’t have queues at A&E.
3. The current system is broken because it depends too much on contracts and internal markets. The ACO is more of the same, we need to scrap the idea of contracts and go back to all staff in the NHS being directly employed by a single, central NHS body.
Concerns about being taken out of the NHS
4. The ACO will not be part of the NHS
5. ACOs are, by definition, private, commercial companies
6. ACOs will be given “full responsibility for NHS and adult social services”, so there will be no way to control how they are spending our money or caring for patients / vulnerable adults
7. NHS national minimum standards (e.g. A&E waiting times, cancer treatment times) will not apply to the NHS
8. The ACO will be able to set different criteria for access to treatment, so there will be a “postcode lottery” where some areas offer treatment free on the NHS that others do not.
Concerns about lack of funding
9. The system is already financially overstretched; all reorganisations cost money in the short-term, even if they save money in the long term. How can the reorganisation take place without taking resources away from front-line care?
10. Some NHS organisations have large debts. Will the Council end up being burdened with these debts?
11. Social Care is currently funded by Council Tax. Will under-funding of the new combined system lead to more pressure on council budgets? Will the government blame lack of cash for the NHS on “local councils making local spending choices”, so Cornwall Council has to choose between cutting the health service or cutting other council services like road repairs?
12. If the main contract is a multi-year commission, how can a price be agreed unless a long-term funding deal from central government is in place? Even if a public-sector provider wins the initial contract, will the government will set them up to fail by under-funding them so that a private company can step in later to pick up the contract?
Concerns about a private takeover
13. ACOs are an invention of American private health companies. The NHS Chief Executive used to work for an American private health company. The Health Secretary has been to visit American private health companies and has co-authored a book which calls for the NHS to be “denationalised”. The Kings Fund (which is providing advice to Cornwall) is partly funded by private companies.
14. Private companies will be able to bid for the “main contract” (i.e. to control a capitated budget, whereby any savings can be taken as profits)
15. If private companies get turned down by the commissioner, they can sue for millions of pounds (like Virgin Healthcare is doing in Frimley)
16. Any new buildings will be financed through PFI, which has been shown to offer bad value for money and a lack of control / flexibility for the people who work in them.
17. Even if the main contract is operated by a public provider, they may be forced / encouraged / allowed to go into “partnership” with private companies to provide up-front cash for interventions which they hope will save money later, enabling them to repay their debts (plus a profit for the private company). Effectively this is “PFI for people”.
18. The main provider can sub-contract work to private providers, where accountability is even harder to achieve. This is an opportunity to make profits at the expense of patients.
19. A combination of all the above will mean that “free” services will become harder to access (longer waiting times, tougher eligibility criteria etc) so more and more people will turn to paying for private alternatives. This “two-tier” health service already exists and will get worse under an ACO so the inequality in health outcomes between rich and poor will continue to grow.
Concerns about the staff working in an ACO
20. ACOs will be governed by contract and company law, so staff will be forced to do what their contracts tell them to do, rather than being allowed to use their professional competence / judgement to deliver what they believe to be the best care for their patients.
21. Bringing GPs into larger “health hubs” breaks the link between the patient and their “family doctor” who knows them well.
22. Forcing GPs to give up their status as independent contractors to become employees of the ACO will undermine their professional freedom
23. Patients will no longer be able to register with an NHS GP, only with a GP employed by the non-NHS ACO.
24. Staff working for an ACO will have worse pay and conditions to those in the NHS
25. The move to an ACO will cause many staff to walk away from their jobs
Concerns about closure of facilities
26. The pressure to make £270m of cuts means that some community hospitals will be closed, as outlined in the original STP plan from 2016.
Concerns about lack of consultation
27. Nationally, there is a judicial review underway because ACOs have not been debated or approved by Parliament. How can Cornwall adopt a new structure for NHS services if it has not been approved by Parliament?
28. Locally, very few staff or patients had even heard of ACOs until a couple of weeks ago. This is a big decision which is being pushed through before the workforce and the community have had time to understand how it will affect them or have their concerns raised.
29. Within Cornwall Council, this decision is being taken by just a few councillors, not the whole council
Other concerns which are harder to categorise
30. “The decisions are being made by people who aren’t health professionals (i.e. politicians should keep out and let the NHS run itself)” AND “The decisions are being made without enough democratic control (i.e. the NHS should not be allowed to make these changes without politicians making the final decision in Parliament and Cornwall Council)”
If you think I’ve missed any, please comment below or email email@example.com