Government’s rubbish answer to Green MP’s question about Accountable Care Organisation safeguards to protect comprehensive healthcare for all

Caroline Lucas MP has asked the Sec of State about safeguards to protect comprehensive healthcare for all, in the face of a new business model for the NHS, based on USA Medicare. The answer is not reassuring.

On 14th September, Caroline Lucas MP asked the Secretary of State for Health written questions about whether there are safeguards in place to make sure that the new model Accountable Care Organisation contract will not result in fewer NHS services being provided than under the traditional NHS standard contract;  and why the consultation on the new Accountable Care Organisation contract will not take place until an unspecified date in 2018.

This is obviously an important question but may need a bit of backstory to understand what an Accountable Care Organisation is and why it risks ending the NHS as source of comprehensive healthcare for all.  (You can skip this if you already know it.)

A bit of backstory

Earlier this year,  Simon Stevens, the NHS England Chief Executive, told the House of Commons Public Accounts Committee that some Sustainability and Transformation Plans would soon get going as Accountable Care Organisations or Systems.

One MP, Anne Marie Morris, was so bemused by what Simon Stevens was saying, she asked if they were all smoking dope. But behind the jargon smokescreen – whether wacky baccy or not, dismantling the NHS into a number of local Accountable Care Organisations opens up the prospect of privatisation on a bigger scale than anything seen so far.

NHS Improvement is working on how to licence Accountable Care Organisation contract holders that are not NHS organisations. And these would be massive contracts.A new business model for the NHS and social care – based on USA Medicare

Accountable Care Organisations are a new business model for the NHS and social care in England that will impose huge spending cuts and restrict services to patients who offer the best return on investment. The probable upshot would be that the NHS would cease to provide comprehensive healthcare for all and turn into a UK version of Medicare – which operates through Accountable Care Organisations. Which is why we have to stop them.

A very waffly answer from Mr Brine

Steve Brine MP, the Parliamentary Undersecretary of State for Health,  gave a very waffly answer that did not in any way address Caroline Lucas’s question of making sure that Accountable Care Organisation contracts do not provide fewer NHS services than under the traditional NHS standard contract.

His answer seems to palm off the issue onto Clinical Commissioning Groups – effectively making them the fall guys, as they have been since they were set up by the 2012 Health and Social Care Act:

“It is for local commissioners to commission services according to the needs of their local population. The Commissioner must run a procurement process that is compliant with the principles of transparency and equal treatment.

The CCG would need to be satisfied that the bidder can effectively provide the services in the required locality as specified within the tender, and the commissioner can design the award criteria to reflect the service being contracted, so could include, for example: ensuring quality, continuity of service, accessibility, affordability, availability, Care Quality Commission assessment, needs of vulnerable patients, teaching accreditation, continuity, and comprehensiveness of the services etc.”

That is disingenuous in the extreme. We know that regardless of contract specifications, providers – whether NHS or private companies – will walk away if there isn’t adequate money to protect their economic viability  – or profits, in the case of private companies.

One example is the Uniting Care limited liability partnership between foundation trusts Cambridgeshire & Peterborough and Cambridgeshire University Hospitals which walked away from the huge alliance contract for Cambridgeshire’s older people’s and adult community services. Another is Torbay and South Devon NHS Foundation Trust, which pulled out of the Torbay and South Devon Integrated Care Organisation that was set up in October 2015.  Private companies like Circle and Care UK have walked away from contracts where they couldn’t make a profit – most notoriously, from a whole hospital (Hinchingbroke).

As Accountable Care Organisation contracts are to operate through fixed whole population payments, this places the risk squarely with the providers: there is no give if more people need treatment, or more complex, costly treatment, than there is money for.

The theory is that this is supposed to incentivise innovation and efficiency – and also to justify profits, in the case of private providers, since profit is meant to be a reward for risk taking. (That was the argument used to justify high interest repayments on Private Finance Initiative loans.) The reality is it leads to gaming the system – not the kind of innovation you’d hope for – and further restrictions and denials of patient care, which  we are already seeing.

Mr Brine seems to be in Alice in Wonderland, where the words mean what Humpty Dumpty wants them to mean. His answer to Caroline Lucas’s question about Accountable Care Organisation contract safeguards continues,

“Neither the [tender] advert nor the criteria should specify the organisational form of the body that will be awarded the contract. It will be for bidding providers to determine the ownership model of that provider.

“This contract is designed to support the development of new, integrated providers that dissolve boundaries between primary, community, mental health, social care, and acute services. In developing a bid to deliver an ACO, prospective providers will need to agree an organisational form and to demonstrate they have support from general practitioners as well as other local NHS providers. Over time, we would expect ACOs to build connections with smaller, voluntary sector providers, enabling them to make a valuable contribution.”

So Clinical Commissioning Groups are to put Accountable Care Organisation contracts out to competitive tender, but apparently  will not be allowed to specify that the “body that will be awarded the contract” is an Accountable Care Organisation since that would mean specifying the organisational form of the body that will be awarded the contract.

And it’s significant that

“prospective providers will need to…demonstrate they have support from general practitioners as well as other local NHS providers”

but there is no requirement that the prospective providers that are developing the bid have to be NHS organisations. Indeed, NHS Improvement is working on how to license contractors for Accountable Care Organisations that are not NHS organisations.

So thanks to Caroline Lucas’s question, we can be pretty clear that there are NO safeguards to make sure that Accountable Care Organisations will have to provide comprehensive healthcare for all, which is the founding and enduring principle of the NHS.

Legal challenges to Accountable Care Organisation contracts

Grassroots campaign group 999 Call for the NHS has brought a claim for a judicial review of NHS England’s Accountable Care contract, on the grounds that it is unlawful.

Four eminent health professionals are investigating grounds for a Judicial Review against the Secretary of State for Health to stop him from introducing Accountable Care Organisations without proper public consultation and without full Parliamentary scrutiny.

2 comments

  1. 999 Judicial page has an error….are they not fundraising now in light of the 4 eminent professionals also doing it (that page worked!)

    • Thanks – I’ve fixed the link now. I just made a mistake when I did the blog post late at night. The 999 Call for the NHS claim for Judicial Review is with the court and they are waiting to hear when the hearing will be. They are still fundraising for their campaign costs but their Crowd Justice crowd funder successfully raised all the legal costs thanks to hundreds of generous donors.

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