David Walsh, Cabinet Member for Adult Social Care at Redcar and Cleveland Borough Council and a Labour councillor, gives an insider’s view of how negotiations over the future of social care are taking shape – and he’s concerned by what he sees

THE three initials of the NHS are well-known and well loved, but now almost every debate about the future of our national health service is overshadowed by three more initials: STP.

This refers to the requirement placed on regional NHS bodies by Health Secretary, Jeremy Hunt, and NHS England to develop “Sustainability and Transformation Plans” (STP).

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In our area, the big debate has been the STP’s assumption that the major trauma centre would be the James Cook Hospital in Middlesbrough, and given that, either North Tees or Darlington Memorial would be downgraded to a “district hospital” and so lose its major Accident and Emergency function. This is a hugely emotive issue as yesterday’s front page of The Northern Echo showed.

However, another dark cloud from the STP agenda is also looming over the North-East, and this concerns the future shape and direction of social care, a crucial service for many of our elderly and disabled, and for local people coping with mental illness or learning disability.

Social care, unlike NHS care, is not automatically free at the point of access and the majority of care – be it domiciliary care in a user’s own house, or in a residential home setting – can be chargeable depending on the recipient's net capital.

Most social care is delivered by private companies or the NHS' and local councils’ arm’s length agencies, with local councils having the commissioning role.

But Mr Hunt expects social care in all of the 44 NHS STP regions in England to undergo complete reorganisation with the aim of each region being run as an “accountable care organisation” (ACO).

This is a variant of the US system called a “Health Maintenance Organisation” (HMO) in which all services are provided via a network of hospitals and clinics run by the HMO company. These provide in turn access to a network of contracting care homes, or home care agencies.

Crucially, HMOs are financed by local residents paying into prescribed private insurance schemes.

Here in the North-East, those of us in social care – council officers and councillors, and the trade unions representing care workers – recently got an unexpected present when the team of senior NHS executives managing the STP process presented us with a document on how they saw the setting up of a North-East Accountable Care Organisation.

This was not just a set of initial ideas – it was a carefully drawn up document covering the type of services, the geographical spread of an ACO and how it would link into the NHS.

The local councils were “invited to join the discussion” on this document even though it had already been delivered to NHS England as an “expression of interest”.

The document is full of mind-numbing managerial jargon but it is clear that the ACO would cover the whole of the North-East and Cumbria, so we could end up with a monolithic model stretching from Berwick to Barrow-in-Furness, making the concept of care tailored to local needs near impossible to deliver.

It was unclear as to what role elected local councils would play in this structure although we were assured we would be “partners”, albeit in a model not of our devising.

At the back of my mind is the nagging fear that the ACOs, if they come to pass, will be simply lambs fattened up for slaughter.

Every week, new sections of the NHS and local authority care are seen as potential candidates for privatisation or externalization. In this region, much routine non-urgent patient transport is via private ambulances, while only a fortnight ago, it was announced that NHS Professionals, the in-house NHS body that operates the nurse bank and the recruitment of other short-term NHS frontline workers, could be be sold off.

If Mr Hunt does push his own agenda, it is eminently reasonable to expect the powerful US HMO companies such as Kaiser Permanente and United Health to be bidding for the huge contracts to run the new bite-sized ACOs if they go out to international tender.

Mr Hunt referenced California-based Kaiser Permanente as a model for the future budgetary arrangements in the NHS at the Commons health select committee in May 2016.

It is clear that the direction of travel of Theresa May’s cabinet is towards a US-style insurance system for social care, run by private companies. The private providers’ share of the NHS market was 2.8 per cent in 2006-7 and has risen steadily to 7.6 per cent in 2015/16. There are no comparable figures about the externalisation of local authority care or public health services in the same period, but it is likely to be similar.

So if you are working in social care – a home care visitor, a council social worker or a residential care manager – be very worried. If you are working in NHS community or rehabilitation services as an occupational therapist, a mental health outreach worker, a physiotherapist or a community nurse – be very concerned

And if you or a member of your family is receiving social care, whether at home and getting domiciliary care, in a residential home, or in a group home setting, find out who may in future be commissioning that service and how the quality of that care will be maintained by the commissioner.

As a long term user of NHS care services said: “The question is whether democracy can prevail and the public can make its demands for proper funding and public provision undeniable by any government.”

That came from Professor Stephen Hawking.