It seems the corporate world has learnt that people are cottoning on to the fact that if you outsource everything from bog roll to chemo nothing works as it's all fragmented, nothing is connected and in addition to losing control of EVERYTHING you also lose that vital organism - INFRASTRUCTURE!

The latest wheeze to come out of those clever boys and girls in suits and offices with table football and communal kitchens - oops! hubs sorry - is INSourcing. Apparently the word and practice has been around a few years but like most things it takes a little while for the buzzword effect to take on.

OUTSourcing is so 2012

Yep time to bring everything "back in-house". Sounds great. 999 Call for the NHS has - along with many others - been crying out for renationalisation of the NHS since 2014. But this InSourcing lark is confusing to say the least.

The discovery of yet another layer of embedded corporate meddling going on with the NHS framework has led us to a state of bewilderment. In addition to the Health Support Services Framework (see blog previous) which sees over 100 large global private companies offering "support" behind the blue logo there is also the NHS Shared Business Services... another layer of partnerships and best practice collaborators who are keen to interfere wherever they are welcome (or not).

And now they are promoting INSourcing... it's not OUTSourcing. Well let Phil Davies from the Shared Business Services explain...

"Insourcing - not to be confused with outsourcing - is where a third party provider of secondary care uses an NHS organisation's premises and equipment to deliver extra clinical capacity, outside of when they are normally in use. In most cases it is essentially an extension of a hospital's existing clinical service."

So... rather than send a patient to the private hospital down the road they will keep the patient within the hospital grounds but still use an external provider to boost the hospital services. And even just use the operating theatres at night when no one else is using them.

Sort of... Outsourcing... sort of thing... only not... well... In, out, shake it all about...

What's even more confusing is the statement on the Alliance Health Group website

"Our members are all NHS consultants and so understand healthcare from management to delivery, and how to make it better. Using our knowledge we assist NHS Trusts to identify their strategy, improve and deliver outstanding patient care."

So this is a company made up of NHS trained staff who are now setting themselves up as Doctorpreneurs. The staff are dividing and dividing... it's not OUTSourcing though. It's INSourcing

So that's a relief.

Only... not really. We might be a bit stupid but it doesn't make sense.

Especially as Labour has now introduced its "INSourcing Revolution"

Democratising Local Public Services: A Plan for Twenty-First Century Insourcing – Labour’s blueprint for a radical overhaul of local government – will be announced today at an event in London held by Labour’s Community Wealth Building Unit, a network of councillors and experts working together to rebuild local economies, renew faith in local services and deliver a renaissance of local government in communities across Britain in the face of austerity.

We're keeping our eyes and ears open along with many colleagues who operate within the Labour Party framework. We are hoping that Labour Insourcing is not the Shared Busines Services type of INSourcing which is not OutSourcing either...

The job of undoing all this complicated (deliberate) layering of corporate meddling management with its murky vague grey areas of crossover and under and around - it's going to be a huge task. Only a call for full renationalisation and a return to a public service model can save the NHS.

We have to force the corporate sector OUT. Does that involve INSourcing? We'll have to wait and see.

999 Call for the NHS has been calling for the Renationalisation of the NHS since we marched for the first time in 2014. We've seen, and supported, FOUR attempts at getting the NHS Reinstatement Bill on the parliamentary table and now in 2019 the issue of Renationalisation/Reinstatement comes around again as we enter the election campaign period where after decades of Austerity...

The two main parties are now both the investors of the future and have sudden access to billions of pounds with which to show just how much they love the NHS and promise to keep it alive.

Labour are currently sitting on the most recent version of the NHS Reinstatement Bill, reworking it apparently. But are they talking about the "Renationalised with NO PRIVATE CORPORATE involvement" that we are calling for? How will we reinstate the NHS as a public service?

Easy answer. End contracts for outsourced clinical services. But there are difficult questions. What about the embedded web of "invisible" services that stretch throughout the NHS, beneath and behind the blue logo? For example...

"What the hell is this?" we hear you say.

Well... since the NHS was fragmented by the internal market brought about by the last Health & Social Care Act 2012 healthcare became a business model not a care model. The new Clinical Commissioning Groups (budget holders)made up of health people, knew next to nothing about auditing, tendering, legal technicalities? So they needed an advisory support service.

In 2015 this was known as the Lead Provider Framework - an easy to comprehend network of Commissioning Support Units divided into 9 geogprahical streams with a list of companies that was already fairly unpleasant.

As things progressed in 2017 with the NHS moving ever closer to the American model, based on the likes of Kaiser Permanante and United Healthcare , with an array of new "innovative and disruptive" models of care from federations, hubs, integrated neighbourhoods, multispecialty community providers, primary care homes and networks never mind a literal headfuck of contracting and financial measures designed to confuse everyone it seems.

But have no fear the Lead Provider Framework is here! Naturally shapeshifting in order to meet the needs of poor commissioners out of their depth in the mire of transformational change. Now so much more than legal, auditing and backroom services. Below is a hint of the changes in 2017/18 - End to End Commissioning... take note of the third red column.

Late last year the transformation of the Support Services became much more complex - reflecting the complex top down restructuring being forced by NHS England and all encompassing as the new 2019 NHS Long Term Plan continued to push the envelope of what is called the LEFT SHIFT - more care in the community, closing A&Es, centralising acute services, selling off public buildings... plus the major onslaught of Digital, Apps all tied up with allure of data trawling for profit.

HEALTH SUPPORT SERVICES FRAMEWORK

This is part of NHS England's description:

The Health Systems Support (HSS) Framework provides a quick and easy route to access support services from innovative third party suppliers at the leading edge of health and care system reform, including advanced analytics, population health management, digital and service transformation... The Framework focuses particularly on services that can support the move to integrated models of care based on intelligence-led population health management. This includes new digital and technological advances that help clinicians and managers understand a population’s health and how it can best be managed.

The HSSF is divided into ten LOTS. Opening the lots is like opening Pandora's Box of USA & Global Corporates.Take a look at just one LOT No.6 - Transformation and Change Support

It is a shock but no real surprise to see some usual horses of the Apocolypse in there - KPMG, McKinsey, PriceWaterCoopers and Optum the subsidiary of United Healthcare of America (where SIMON STEVENS spent 9 years as President of Global Strategy) but then dig deeper into the "smaller names" and you discover more USA and global connections.

BDO, Capgemini, Centene, DGX Technology, GE Healthcare Finnamore Ltd are worth a look and even Moorhouse Consulting Limited looks innocent enough until you wonder what they are as "An Expleo Company" more of the same...

And what is Lot Number 6 all about?

Well NHS England kindly provide a description. Provision of a range of expert advice, analysis, transformational and change management capability to design and build the necessary infrastructure for an ICS / STP function effectively. Services include but are not limited to (edited list):

Patient pathway optimisation and care model design

Specialist advice on organisational redesign, governance and payment and contract reform

Communications and engagement

Primary Care at scale support

Is this supporting or twisting the arm of the NHS? Seems a great deal more significant that mere back room services.

Make up your own mind with THIS LINK

Our ask is simple. We know the task is epic and complex in its operation. But how are we going to rid the NHS of the corporate vultures? How do we remove the web of private providers who have now set up home in the framework? It can be done. But we need a government with the will to take it on. And that WANTS to see the NHS restored to a unified public service of support for all.

Renationalisation is about the stopping and rejecting of the USA Healthcare Model being promoted by NHS England, Health Secretary Matt Hancock with support from The Kings Fund, Nuffield Health and numerous other "think tanks". As an Addenbrookes innovation department staff member told us: "We're not innovating or integrating anything to do with clinical care. The only thing we're integrating is the accounts system".

So we need politicians who understand the future of our NHS rests on our ability to reject the profit & insurance model that is being foisted upon us.

Simple.