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999 Call for the NHS

A grassroots NHS campaign. Not affiliated to any of the political parties.

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By 999 Call for the NHS, Nov 11 2019 09:33PM

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.








By 999 Call for the NHS, Jan 11 2019 10:59PM



Today was my Diabetic half-yearly checkup. A good thing. Blood pressure, weight, draw a bit of blood. I love my diabetic nurse (let’s call her Susan) because she listens, she asks questions about my life, we swap notes on current NHS politics, she is an expert in drawing blood out of my always reluctant hard-to-find veins.


I wonder how Susan is? I’ve not seen her for over a year and a half. I miss her. And I don’t know who I will be seeing today as i pull open the GP Surgery door.


My heart sinks as I tap the digital screen on the wall just inside the GP Surgery door. (Another new software I notice). Receptionists are far too busy doing important stuff to say “good morning” or smile. I know because I can hear them laughing behind the shutters on their windows.


The login screen tells me I am the next patient with (not real name) Julia HCA. How many people here today actually know what an HCA is I wonder? The Nurse’s Room is still next to the waiting room. I know this because the door still has the room plaque “Surgery Nurse” on it - in a nice understated NHS blue.


But beneath it now sits a much larger piece of white plastic with a rather heavy clumsy black font displaying HEALTH CARE ASSISTANT. Being an artistic spirit my heart aches at the complete lack of care and aesthetic sensitivity thats gone into the creation of this overbearing plastic functional sign.


It’s ugly.




My heart sinks further when the door opens and I recognise Julia HCA. My first encounter with Julia HCA was the last time I saw lovely Diabetic Nurse Susan.


That appointment I returned home with four large wads of cotton wool - stuck to both arms, back of both hands (large bruises later) where the needle had been swivelled, twisted and jabbed in an attempt to extract my life-source. On that occasion. after four arduous attempts, Julia HCA had accepted defeat and called Diabetic Nurse Susan away from her very important paper-work (in the next room) to draw my blood.


One sharp, a prick so small I didn’t feel it at all, a smile and a line of friendly genuine chat - two tubes of blood were filled easily. Perhaps my relief at seeing Diabetic Nurse Susan was a factor? I miss Diabetic Nurse Susan.


Anyway... Julia HCA tells me to take a seat by the bed. The chair that is facing away from her. I turn my head so I can see Julia HCA - the other human in the room. Julia HCA is busy reading her screen and tapping her keyboard. She tells me she is going to measure my blood pressure, weigh me and take some blood. Because that is what the screen tells her presumably. When Julia HCA finally looks up I’ve already rolled up my shirt sleeve and placed my arm on the bed.


Without looking at me Julia HCA slips the cuff of the Blood Pressure machine onto my arm. She says firmly “Don’t talk or move while the machine is working.”


She turns away to the counter and gets busy opening the requisite needle pack, card tray and plastic tubes that drawing blood will require.


I don’t move or talk. I’m feeling the pressure. I stare at the PAID FOOT CARE leaflet stuck to the wall...



The blood pressure machine stops whirring and the cuff begins to deflate. Julia HCA scribbles on her pad. She does not offer a comment on her scribbling. I ask what the figures mean. It’s a little over the target. I refrain from suggesting why that might be.


And so the fun bit. Drawing the blood. Today is better. Julia HCA has had 18months more practice. Today only takes three “small prick” attempts and a weary “oh come on” sigh before finally stabbing a vein (in frustration?) and rich dark red fluid flowing forth. I experience a combination of deep relief she does not need to stab me again, gratitude that she has improved, and disappointment that I will not get to see Diabetic Nurse Susan.


So just two large cotton balls taped to my arms this visit. Now...shoes off, pockets emptied and I stand on the scales. Julia HCA tells me my weight in kilos which i have also read from the digital window. Julia HCA goes to the computer. Silence is broken with a “oh 2016 is the last time we weighed you...”.


We both agree that’s bullshit - my words not hers. But Julia HCA cannot tell me how much I have lost since my last visit because its not on the screen. I’m disappointed but resist voicing my internal “for fucks sake”.


Shoes on in silence. Slipping jacket on I thank Julia HCA. Nothing much more to say. Completing her computer screen box-ticking Julia says “Goodbye, see you in 6 months time”. I leave. I realise that throughout this entire clinical process Julia HCA and I have not made eye contact. Not once.


The questions begin as I walk home. (I’m lucky not needing to travel far). Where is Diabetic Nurse Susan? If Julia HCA is replacing her with her skills as the conduit twixt me and computer screen database what is Diabetic Nurse Susan doing? Is she next door doing very important computer work? Is she being a “Martini Nurse” - out and about putting ‘right care in the right place at the right time’ into the community? Or perhaps she’s at a Clinical Commissioning Group or Sustainability & Transformation Partnership meeting offering her valuable clinical expertise towards integrated accounts packages?


This is my experience of the modern NHS GP surgery. I don’t doubt there are good people in them still. But this experience has been faceless with no sense of a relationship, connection or purpose between me and the care professionals - those who once were praised and rewarded for their personal human interaction skills but now are forced to fit the machine of the “health economy” which is one more American idealogical phrase that has crept into our NHS. Scary article warning: PwC New Health Economy in an age of Disruption



Disruption is about right. My relationship with Diabetic Nurse Susan has been disrupted. Ended probably. I have no personal connection now between my sense of looking after myself (Preventative Care - what the NHS claims healthcare is all about) and a healthcare professional who actually gives a shit. Doctors have been warning about the dangers of destroying the doctor/patient relationship since 2012 - the Year of NHS Disruption


Disrupting patients and staff, denying proper human interaction and replacing it with a computer screen or an app only creates an apathy in me that gives rise to me being a patient who doesn't really give a shit either.


Can’t blame Julia HCA. She must know she’s cheaper and not respected in the scheme of things.

Can’t blame my Diabetic Nurse Susan. She’s off somewhere no doubt trying to be integrated and keep her job afloat.


Blame the GP surgery? They’re struggling to find staff on limited funds, under yet more pressure from NHS England to join the new, ultimately faceless, Super Hubs which are supposed to cover 30-50,000 population areas. Even though there is little evidence to prove they will lead to better healthcare.




I can definitely blame NHS England and NHS Improvement along with numerous other business busybodies like the Kings Fund, Nuffield Trust and Health Foundation who with their research studies are “wreckless driving” this inhuman new model of care that will produce better financial outcomes for company shareholders but will not produce better healthcare for patients - not here or anywhere.


It’s been a busy week with new job and campaign admin. I have yet to catch up with all the fuss and nonsense of the new NHS Long Term Plan. Part of me feels there is no point in reading the f**king thing. More of the same as the last bastard 5 Year Forward View plan that has laid the foundations for this “new model of care” we are seeing not so much evolve but explode (disruption don’t forget) inside our NHS.


Why are we allowing Simon Stevens, Chris Ham and others to adopt the Accountable Care Organisation healthcare model following the American model of care when it is universally recognised as being just a bit crap (utter shite) and "based on faulty assumptions, poor economics, and junk science"


This is just one reason why 999 Call for the NHS are continuing our fight in the courts. We have to keep fighting for a healthcare system that is human based, focused and managed. Not a corporate money making machine where patients and doctors are just faceless cogs in the economic machine.


LINK TO OUR LEGAL FIGHT

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