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7th November 2013 

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Trojan Horse     
News and Comment from Roy Lilley

Thursday is always a busy day at the market.  Since just after five the vans have arrived and been unloaded.  Stalls pitched, gas rings heating food of all sorts.  Rails of dresses, two-4-one.  The fruit and veg, the Xmas wrapping paper and Santa Socks.  Antiques, bric-a-brac, tat and bargains.  Cheese, cakes, bog-rolls and CDs.  It's all there.

 

By ten it's busy and eleven it's bustling, by noon it's packed.  Steaming hot bowls of this and that.  Bog-offs, rip-offs and money-offs. 

 

Make your way to the end of the central avenue and there it is.  A quiet pitch being worked by a familiar face; the owl specs, the Harris Tweed flat cap, the full length Colorado sheepskin-coat.  Yes, it's the Department of Health's Bob Ricketts.  'Roll-up, roll-up!  Buy one get one free!' He cries.  'It's the great CSU sell-off'.

 

'Come closer ladies and gentlemen... do I have a bargain for you.... a bargain?  No... this is rock-bottom.  I'm not asking a million pounds, I'm not asking �1,000.  Not a hundred, not even a tenner.  Clinical Support Units, not part of the NHS, not subject to FoI, no need for a public audit.  These little beauties are perfectly formed money making machines that you can take away today.  Roll-up, roll-up; they are Free!  Yes, that's it!  They are Free!  Each one comes with my personal, lifetime guarantee to make you money, make you smile and make you rich, rich, rich.  They come with all the batteries, the staff, I'll even throw in the photo copiers!  What a bargain.  This is a once in a lifetime give-away.'

 

A couple of days ago the �walled FTreported that a number of private equity firms have been approached regarding "taking over" Clinical Support Units. The FT thought that CSUs are attractive to the private sector because they "are not big businesses but they are likely to be increasingly influential and control billions of pounds" and that one bidder "could try to buy all 19 with the aim of creating economies of scale". They reported Bob Ricketts saying: "Most of the commercial providers are having a good look at it but will reserve judgement until later in the year."

 

Are they the deal of the century?

 

CSUs are the chimera invention of the Big-Beast.  Faced with a burgeoning redundancy bill CSUs were created as a way of TUPE-ing NHS staff out of the NHS but keeping them arms-length-busy in the NHS.  CSUs are not mentioned in the H&SCAct.  They were created to provide a back-stop, back-office for fledgling CCGs.

 

PCTs had about �57 a head of population to run their admin. CCGs ended up with about �25.  There was no way they could run a back-office on that kind of money.  They had two options.  Form into larger CCGs or pool their admin-cost money and use, collectively, the services of CSUs to run back offices.  CSUs have proved less than the first choice for many CCGs, many of whom have resented being bullied into using them.  Some CCGs have decided to run their own commercial affairs.  CSU numbers have been whittled down to just 19 to cover England. 

 

The DH has a problem.  By 2016 CSUs have to be off the NHS's books as their grace period as chaperoned NHSE organisations comes to an end.  They could be taken over and run by their staff, as a social enterprise or the private sector encouraged to buy-in.  The usual suspects, Capita, Serco, Atos, and McKinsey are having a look.  KPMG are not.

 

Are they really money makers?  CSUs could do much more than buying the bog-rolls and paying the wages.  They could plan care-pathways, formularies, data analysis, referral management and hire staff, run OOH and extend services into practices even take on practice management.  There is also; fleet management, locum services, aggregating utility bills and discounts, buying consumables.  They might become the voice of primary care and lobbyists.  They could manage pensions and property portfolios; refurbishment, repairs, renewals, insurance, health and safety inspections and liaise with the CQC.  They might organise CPD, training, public health messages and screening programmes.  If they are big, efficient and provide a 'now' service CCGs and practices will be tempted to give them a go.

 

Will they make money?  Not now, not next year, but assuming there is no political upheaval in 2015, CSUs, as a long term punt, with payback measured in years not months might make them Primary Care's Trojan Horse.

   

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