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You can find the current article at its original source at https://www.theguardian.com/society/2018/jan/02/suspicions-over-accountable-care-organisations-in-the-nhs
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| Suspicions over accountable care organisations in the NHS | Suspicions over accountable care organisations in the NHS |
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| I am one of those who are deeply suspicious of the accountable care organisations (ACOs) that Bruce Keogh describes in Panglossian terms but does not name (As the NHS turns 70 we need it more than ever, 1 January). Since the release of Simon Stevens’ Five Year Forward View in 2014, we have been told how the patient is at the centre, with care closer to home, “no decision about me without me”, but have watched as services get more difficult to access despite the wondrous efforts of the workforce, both NHS and in the care sector. Lack of funding and being forced to “make savings” have been the mechanism that has caused the crisis, but the fragmentation and outsourcing that followed the Health and Social Care Act of 2012 have been expensive and damaging too. | I am one of those who are deeply suspicious of the accountable care organisations (ACOs) that Bruce Keogh describes in Panglossian terms but does not name (As the NHS turns 70 we need it more than ever, 1 January). Since the release of Simon Stevens’ Five Year Forward View in 2014, we have been told how the patient is at the centre, with care closer to home, “no decision about me without me”, but have watched as services get more difficult to access despite the wondrous efforts of the workforce, both NHS and in the care sector. Lack of funding and being forced to “make savings” have been the mechanism that has caused the crisis, but the fragmentation and outsourcing that followed the Health and Social Care Act of 2012 have been expensive and damaging too. |
| Those costs and inefficiencies will not go away with the introduction of ACOs but the role of multinational health businesses will be much enhanced by their involvement as “partners” at the heart of the fixed budget “complete care systems”. They will be influential in decisions about who qualifies for healthcare and who will be told their needs are social care and therefore means tested. They will shape the pattern of subcontracting and the percentage of NHS funding going to private providers. We also need to know much more about how the technology-based improvements are to be paid for. Most of the suppliers are the same companies getting their feet under the table of the ACOs. Almost certainly, private finance will be used, despite what we know of the horrendous long-term costs of PFI. | Those costs and inefficiencies will not go away with the introduction of ACOs but the role of multinational health businesses will be much enhanced by their involvement as “partners” at the heart of the fixed budget “complete care systems”. They will be influential in decisions about who qualifies for healthcare and who will be told their needs are social care and therefore means tested. They will shape the pattern of subcontracting and the percentage of NHS funding going to private providers. We also need to know much more about how the technology-based improvements are to be paid for. Most of the suppliers are the same companies getting their feet under the table of the ACOs. Almost certainly, private finance will be used, despite what we know of the horrendous long-term costs of PFI. |
| I understand that Jeremy Hunt intends to use secondary legislation to give a legal framework for these changes, thereby sidestepping the scrutiny of parliament. The framework will be company and competition law so the new bodies will be protected by commercial confidentiality and not subject to FOI. Indeed, when it comes to accountability of the ACOs, it may eventually be to shareholders, not patients or parliament. | I understand that Jeremy Hunt intends to use secondary legislation to give a legal framework for these changes, thereby sidestepping the scrutiny of parliament. The framework will be company and competition law so the new bodies will be protected by commercial confidentiality and not subject to FOI. Indeed, when it comes to accountability of the ACOs, it may eventually be to shareholders, not patients or parliament. |
| The crowd-funded legal challenge to this legislation is still short of its target and readers may well wish to contribute. There is also an early day motion, which needs more MPs to sign up so that a debate can be forced. Sue Vaughan (retired GP)Little Melton, Norfolk | The crowd-funded legal challenge to this legislation is still short of its target and readers may well wish to contribute. There is also an early day motion, which needs more MPs to sign up so that a debate can be forced. Sue Vaughan (retired GP)Little Melton, Norfolk |
| • My experience of current commissioning arrangements in the NHS is that the authorities are hardly accountable to the local population at all. Public meetings are almost always either preceded or followed by private meetings in which all the important decisions are taken. They are obliged to consult local people, but not to pay any attention to what they say, and the public are almost never given options on which they can vote. They are currently accountable to the secretary of state but even this potential safeguard will be lost if independent accountable care organisations are established, and there is an obvious danger that money currently allocated to health services will be siphoned off locally to provide better education, transport, housing, and social services as Bruce Keogh mentions. Challenges in the courts will hopefully ensure that this possibility is properly examined in addition to privatisation issues.Dr Richard TurnerBeverley, East Yorkshire | • My experience of current commissioning arrangements in the NHS is that the authorities are hardly accountable to the local population at all. Public meetings are almost always either preceded or followed by private meetings in which all the important decisions are taken. They are obliged to consult local people, but not to pay any attention to what they say, and the public are almost never given options on which they can vote. They are currently accountable to the secretary of state but even this potential safeguard will be lost if independent accountable care organisations are established, and there is an obvious danger that money currently allocated to health services will be siphoned off locally to provide better education, transport, housing, and social services as Bruce Keogh mentions. Challenges in the courts will hopefully ensure that this possibility is properly examined in addition to privatisation issues.Dr Richard TurnerBeverley, East Yorkshire |
| • In his article defending plans to introduce American-style accountable care organisations into this country, Professor Bruce Keogh says some people may question the funding model of the NHS. But, with all due respect to him, it is not clear that he supports the NHS funding model himself. He talks about a commitment to a taxpayer-funded service and a service that is free at the point of use, but does not mention the third pillar of the NHS model, the fact that doctors nurses and ancillary staff are paid directly by the government, not by Richard Branson or the CEOs of some American healthcare conglomerate. Is Professor Keogh happy to see the trend to private provision in the NHS continuing and increasing?Brendan O’Brien (retired GP)London | • In his article defending plans to introduce American-style accountable care organisations into this country, Professor Bruce Keogh says some people may question the funding model of the NHS. But, with all due respect to him, it is not clear that he supports the NHS funding model himself. He talks about a commitment to a taxpayer-funded service and a service that is free at the point of use, but does not mention the third pillar of the NHS model, the fact that doctors nurses and ancillary staff are paid directly by the government, not by Richard Branson or the CEOs of some American healthcare conglomerate. Is Professor Keogh happy to see the trend to private provision in the NHS continuing and increasing?Brendan O’Brien (retired GP)London |
| • So Bruce Keogh is yet another apologist for the atrocious and dysfunctional Tory government that we are lumbered with, unlike Lord Adonis who has been prepared to air a few home truths in his resignation. Keogh is attempting to justify the government’s “privatisation by stealth” policy but most of us NHS users are far from convinced. | • So Bruce Keogh is yet another apologist for the atrocious and dysfunctional Tory government that we are lumbered with, unlike Lord Adonis who has been prepared to air a few home truths in his resignation. Keogh is attempting to justify the government’s “privatisation by stealth” policy but most of us NHS users are far from convinced. |
| How long before Virgin Care and the other money-grabbing contractors realise that they have overbid on their contracts and plead for a government bailout which will doubtless on past history be provided? Of course, another Virgin-branded company has already honed its skills in wriggling out of contracts that are not proving sufficiently profitable, ie Virgin Trains East Coast.David FeltonWistaston, Cheshire | How long before Virgin Care and the other money-grabbing contractors realise that they have overbid on their contracts and plead for a government bailout which will doubtless on past history be provided? Of course, another Virgin-branded company has already honed its skills in wriggling out of contracts that are not proving sufficiently profitable, ie Virgin Trains East Coast.David FeltonWistaston, Cheshire |
| • Join the debate – email guardian.letters@theguardian.com | • Join the debate – email guardian.letters@theguardian.com |
| • Read more Guardian letters – click here to visit gu.com/letters | • Read more Guardian letters – click here to visit gu.com/letters |
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