Why be afraid of Integrated Care?

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Looking at the GOV.UK website you may well be wondering why every region of the country has a Save the NHS Campaign?  The website talks about so many positive changes going on, more funding, better care, greater integration of health and social care and so on. So why is there are a host of books, websites, films and national campaigns dedicated to saving the NHS when everything all is so rosy in the garden of our healthcare?

You may be wondering what all the fuss is about but then you may remember all the stories of people on waiting lists, patients being treated on trolleys in hospital corridors, of nurses relying on food banks or doctors in traffic accidents because they are driving home after a shift when they are just too tired.  You may be worried about how you can get a GP appointment quickly or how you can get mental heath support for your child, and then you may realise the GOV.UK website is lying to us all.

Terminology used in the NHS structure is often confusing and designed to hide a very harsh reality.  None more so than the term Integrated Care Systems.   New legislation was heralded by even the ‘Guardian newspaper as ‘reining in the privatisation of the NHS’. It would seem its not just our Government that is wanting to deceive us, even so called ‘left wing’ newspapers do so.

The Guardian article talks about the removal of Section 75 from the Health and Social Care Act of 2012.  This section forces NHS bodies to put out to tender any contract worth at least £615,278.  This has led to a record £9.2bn of the NHS budget being handed to private healthcare corporations – despite Matt Hancock’s promise of ‘no privatisation on his watch’.  So why are we getting upset about the removal of this Section?

The reality is very different to what the Guardian is claiming.  Removal of  Section 75 will simply remove any regulations on competition and could lead to contracts simply being handed to private corporations.  Which leads us back to the point about Integrated Care.

Integrated Care is on its way.  Formerly known as Accountable Care until the Government realised this gave the game away and that by using the same term as the States we all became alarmed  that we were heading to a US style system.  So they changed its name – nothing else.

Integrated Care does not mean a hoslistic approach to healthcare, that integrates the NHS with social care and provides greater public accountability.  The removal of Section 75 may mean that Integrated Care Provision could just be handed to a private corporation – but privatisation is not the only problem with Integrated Care.

Our Government is hoping to do a complete overhaul of our NHS structure (again), redesigning it to look remarkably like the US system.  This will come at a cost of £11bn which will largely be funded by a quick fire sale of NHS estate.

If you are offered a choice between treatment in a NHS hospital or the NHS funding your treatmment at a private hospital it may be very tempting to choose the private option.  But, when enough of us do this they can claim the NHS service is ‘underused’ and justify closing it down and selling off the building.  You paid for the NHS, we all did, we need to stand firm and insist our treatment is provided by the NHS.  Once it is gone, it will be much harder to get back.

The system when it has been redesigned would have at its heart the means to restrict our access to healthcare.  Integrated Care Providers will be each given a set amount of money to spend and if need requires more expenditure it will be left unmet.

They plan to cut and centralise acute emmergency hospitals.  Local district general hospitals will be turned into either planned care clinics or urgent care hospitals where patients can be stabilised before being moved to a major trauma and emergency department. More and more services will be delivered out of hospital in large primary care practices.

Access to treatment on the NHS will be restricted for us all based on financial considerations as opposed to a medical judgement.    This will undermine our doctor’s professional competence and places GPs in a scenario where they are offered financial incentives to deny us hospital referrals that they know we need.

Most of us will find our local GP practice moves into a large multi-speciality hub that may be a considerable distance from our homes.  If we phone for an appointment we will be speaking to a ‘care navigator’ who will have no clinical training and will be directed by a computer programme in the same way call handlers of the 111 service are.  Patients will be offered appointments with associate staff of a lower skills grade than our own GP.  The doctor patient relationship will be a thing of the past.

This is the end point in a steady move to the US-ification that began under Tony Blair’s ‘New Labour’ and ended when Simon Stevens announced his Five Year Forward View in 2014.

Our Government has a duty of care to us all. Every time we protest their actions or seek a judicial review to remove a decision to close a particular NHS services we send a loud message reminding them they have a responsibility to not go down this path.  Long may it continue.

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