John Lister –

Two weeks ago The Lowdown warned of plans being hatched by NHS England and local “Integrated Care Systems” (ICSs) and Clinical Commissioning Groups (CCGs) to force through far-reaching changes as soon as the lockdown period and crisis measures are eased off.

Many of these have been accepted with minimal discussion as emergency measures to deal with the Covid crisis, but which would be controversial as a permanent arrangement.

They include establishing a “new normal” of predominantly ‘virtual’ primary care and outpatient services, along with remote diagnostics, new approaches to triage, workforce models, use of volunteers, remote working, “pace and urgency to decision making,” and new “financial models.”

It seems that the changes accepted as temporary measures are already being cemented in. NHS England’s plans in London make clear that to reverse away from any of these changes now requires the prior agreement of the Regional office.

NHS England have also begun to further cut back local accountability by establishing 18 so-called ‘Integrated Care Systems’ covering even wider catchment populations than most CCGs, but which are not public bodies, and are outside of existing legislation.

At the same time NHS England is encouraging the development of plans without any public discussion or scrutiny during the lockdown period, and “streamlined decision-making” – in other words minimal if any public consultation.

Even though the CCGs have continued to function behind the scenes, and some are meeting online while public attention is focused on the Covid crisis, it’s clear that in many areas the local government and other bodies that should be scrutinising their plans and performance have been suspended, and are yet to get going.

After the prolonged dislocation of the purdah period prior to the general election, and the cancelled meetings and lockdown from March, many scrutiny committees will be months out of date, and face a deluge of densely-written documents when they eventually begin meeting again – especially where CCGs have been forging ahead with plans behind closed doors.

Also during the lockdown the insidious growth of NHS England’s reliance on the private sector has accelerated. Private contractors and management consultants have been picking up lucrative contracts, often without competition or tendering, some at the discretion of the Cabinet Office rather than the NHS.

NHS England has been making it abundantly clear that they see the private hospitals playing a key role in restarting elective care, having block-booked up to 10,000 beds in private hospitals for the pandemic, few of which have been used, and many of which have now been released for the hospitals to treat private patients or NHS-funded elective treatment.

According to the HSJ these beds are now seen as essential: “NHS trusts have been told to explain to the centre how they might best use private providers to achieve this goal. This intelligence will inform how and if NHSE might renegotiate the contract.”

It is conspicuous that this focus on using private hospital beds comes at a point where tens of thousands of NHS beds are still closed: given the long-held wish of CCGs to scale down even further the numbers of acute hospital beds, the question must be whether, rather than when, many of them will be reopening in the foreseeable future.

While most eyes remain on the Covid-19 crisis, the challenge in many areas will be to keep track of far-reaching changes being implemented with little or no publicity or public consultation.

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John Lister
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