Unaccountable, undemocratic and unaffordable – The NHS Long Term Plan

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Our Government announced in December its Long Term Plan for the NHS.   All dressed up in sugar coating this was simply attempt number three to somehow fill the wallets of private healthcare corporations while kidding the population that everything in the garden was rosy.

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They started with the Health and Social Care Act which dissected our NHS into a conglomerate of different providers while making substantial budgetary cuts.  When uncontrollabe deficits became the norm across CCGs and NHS Trusts plan 2 was announced resulting in England’s NHS being divided into 44 regions.  A Sustainability and Transformation Plan Board was appointed for each region and were charged with drawing up plans in secret to eliminate all deficits within five years.   They were met with huge public opposition, they have frequently had to reverse aspects of their proposals and nothing is really improving.  Which brings us to the point where plan three was unveiled.

The NHS Long Term Plan is yet another top down re-organisation of the NHS.  It could be seen through the rose tinted spectacles as providing more money for mental health, encouraging advancements in the use of digital technology or any of the other 60 uncosted commitments it makes.  John Lister, editor of Health Campaigns Together, describes it as being: “An unrealistic wish list of developments completely divorced from the real constraints on resources.”

But if you look at it all through the eyes of a realist you will see little more than a drastic push towards the complete privatisation of our NHS that allows no consultation with the people and communities affected.

The plan aims firstly for government to rescind regulations enforcing contracting requirements of the 2012 Health and Social Care Act that CCGs parcel up services and put them out to competitive tender.  We know this breaking up of our NHS into a mass of different providers has made the NHS inefficent and have called for this change.  But we need to be extremely wary of what replaces this policy.

The Long Term Plan proposes a new centralised structure with Engand’s health service divided up into 44 Integrated Care Systems (ICS) within two years.  These will each be montired by regional directors and a network of joint NHS England and NHS Improvement.  They aim to reduce the number of CCGs down to one CCG per ICS, cut their budget by 20% and ultimately the running of each ICS will be up for grabs by private contractors.

In our area we come under the Sussex and East Surrey STP Board.  The region has been divided into three place-based plans as it covers such a wide geographical area with many health inequalities.  In East Sussex we are covered by the East Sussex Better Together plan.  They have already formed an alliance of the two CCGs, East Sussex Healthcare Trust and East Sussex County Council with Sussex Partnership Fundation Trust working as an affiliate to the alliance.

They are already talking about working as an Integrated Care System. At the moment this is just in a trial stage.  But we are one small step away from having a single organisation responsible for commissioning and providing health and social care across East Sussex.  The plan is that the ICS for East Sussex, and every other area, will be given each year a set amount of money and if need exceeds that amount it will be left unmet.

As a population we are not getting any say in these decisions.  Our local authorities must refuse to work with these ICSs if they have any belief at all in democracy.    The aim is to eliminate all deficits by 2023/24, there may be some positive news in this plan about more money for mental health but this is money simply moved from elsewhere in the NHS.

The plan also aims to reduce down the number of GP practices in England from 7,500 to 1,500.  Multi-speciality hubs will be created lumping  together services and GPs to serve large populations.  This may destroy any hope we have of being able to keep that patient-doctor relationship that is of particular benefit to mental health patients.  The thought of never seeing the same GP twice is one many people will not relish.

Other proposals are to give every patient the right to a digital first consultation, however there are no plans to give a right to face-to-face consultations.   The advantages of skype-type consultations are something that many would dispute.

There are plans to cut 1/3 of all outpatients appointments and for trusts to increase the funds they get from charging overseas patients.  GPs have a list of treatments and medications which they can no longer prescribe, and that list continues to grow.

This Long Term Plan is our Government’s third rehashing of policy on the NHS, it is the most drastic push towards privatisation of them all.  We could console ourselves with the fact that the other two plans have failed so perhaps this one will too.  But we can see the how the Conservatives are becoming increasingly desperate to fully privatise the NHS.  We need to become increasingly desperate to stop them.

This is not some wierd game of cat and mouse with the public chasing our government into a political corner.  This is about us, as the public, recognising we have a government playing games with our lives and the lives of our friends and families.  This is about our determination to force recognition of that fact.  People have a right to healthcare, enshrined in the Universal Declaration of Human Rights.  Our communities will be damaged, our country will become less productive and lives will be lost every time our healthcare service is reduced.  This Government is making a habit of crossing red lines but, so are we if we stand back and allow them to.


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