The NHS has seen one market-driven reorganisation after another in recent decades. Now buckle-up for another huge upheaval! This year sees the introduction of what’s called ‘Accountable Care Organisations’ (ACOs) to the NHS in England. But will this be any better for patients and staff than previous shake-ups? And why hasn’t it attracted much attention?
ACOs represent the most significant change to our NHS since the 2019 Health & Social Care Act. We should all take an interest, because they will undoubtedly affect the care we receive for the foreseeable future.
The ACO model takes its’ cue from the healthcare system in the United States, where evidence shows, at best, a mixed picture in terms of results.
NHS services are being reduced and centralised, so expect longer waiting times in A&E – already the worst on record – and General Practice, with hundreds of practices being forced into closure.
Property made vacant in the process is already being sold off to pay towards the costs of implementing the new model. Alarmingly, your NHS care is more likely to come from a private provider, whilst the number of treatments available decreases.
After you’re eventually seen and accepted for surgery or cancer treatment, you’ll be waiting even longer to receive it.
ACOs are the final stage of NHS England’s ‘Five Year Forward View’. This plan assumes that closer co-ordination, based on integrated budgets and management – between the NHS (providing healthcare) and Local Authorities (providing social care) – will lead to a better preventative health approach, enhanced community services, an overall reduction in demand for expensive hospital care.
However, the Local Government Association itself has found little evidence on the ground of such co-operation taking place, and with both the NHS and Local Authorities in a state of instability following severe cuts to funding, it is a questionable time to be dedicating billions of taxpayers’ money towards reorganisations.
The National Audit Office, reporting on the Better Care Fund set up to facilitate the programme, concluded that it “has not achieved the expected value for money, in terms of savings, outcomes for patients or reduced hospital activity, from the £3.5 billion spent through the Fund in 2022-16.”
In 2019, the Independent Healthcare Commission reviewed the impact of an ACO-style trial in North West London. Chaired by Michael Mansfield QC, it is the only full independent assessment of its kind that’s been conducted to date. Its findings are damning:
1. Cutbacks were being targeted on the most disadvantaged communities, and the public consultation was inadequate and flawed.
2. The cost of the programme (£1 billion) did not represent value for money, and there was no business plan to show the reconfiguration was deliverable.
3. NHS facilities had been closed without adequate alternative provision in place, and the plans seriously underestimated the increasing size of the population and its need for services.
Carillion’s collapse underlines the serious consequences that can arise from outsourced contracts for public services. Yet there’s nothing to prevent a private company or global corporation being a constituent member or even taking over the 10-15 year ACO contract.
Indeed, policy analyst Stewart Player, commenting on the current situation in the South West (which is transitioning towards an ACO), observes that “the range of private healthcare provision in Somerset is remarkably extensive, so much so in fact that [it] can no longer be considered a public entity.”
In response to a judicial review launched by Professor of Public Health Allyson Pollock and the late Professor Stephen Hawking, the government and NHSE have commenced a public consultation on Integrated Care Providers (ICPs are the new iteration of ACOs), whilst simultaneously continuing to push ahead with their implementation.
The House of Commons Health & Social Care Committee has not meaningfully engaged with the serious concerns surrounding ACOs, instead calling for improvements in the way in which the changes are communicated to the general public.
The NHS is one of the most efficient and fair healthcare systems in the developed world, using just 9 percent of GDP. So why do we persistently look to the United States for inspiration, when it has the most expensive and unjust healthcare, taking up 20 percent of GDP and failing millions of ordinary Americans?
And how is Simon Stevens – CEO of NHS England and a former President at United Health, the largest US health insurer – able to fundamentally reshape a public service without need of legislation?
For all our sakes, it’s crucial that MPs get to grips with this unnecessary and potentially disastrous revolution happening in our NHS. The omens aren’t good though – a recent survey found that a third of MPs don’t understand ACO terminology. But understand it they must, if they are to avoid their constituents’ suffering.
In light of the urgency and lack of awareness, public policy think tank Public Matters are writing to councils throughout England to offer consultation on their engagement with the ACO/ICP process. Subscribe to their newsletter to stay updated on how to get involved in your locality.
Dr Ameen Kamlana is a GP in east London. For more, follow him on Twitter @ameenkam