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Cheerleading For Accountable Care - the role of the Kings Fund

By 999 Call for the NHS, Jan 31 2018 12:07AM

Adrian Mercer & Jenny Shepherd examine the "think-tank" affection of Accountable Care.

The Kings Fund was founded in 1897 to help the poor access healthcare in London.

This appears to be the last thing on its mind today as it takes on a leading role promoting accountable care across the NHS. Its recent publication, copied into a BMJ blog, is the low point in its history: combining blindness to current privatisation of the NHS, a naivete about the future intentions of the private sector, whilst advocating changes which undermine the founding values of the NHS.

The Kings Fund promoted their paper with a helpful screen shot

These paragraphs deserve scrutiny.

The Kings Fund suggests that there is "... no evidence that private companies are taking on a bigger role in developing accountable care."

This, of course, is only true if you ignore the extensive role of global companies such as

Centene in Nottingham,

BDO in the West Midlands,

and the pervasive, yet hidden, role of private commissioning support units

that are busy developing Vanguards and promoting accountable care nationwide.

The Kings Fund also claims that private providers of clinical services are not muscling in on NHS contracts from commissioners that are early adopters of the Accountable Care business model. But set this against the statement from the Chair of Totally Ltd that the trend of shifting hospital services into the community - the hallmark of Accountable Care - amounts to a “massive market opportunity”. One which Totally Ltd intendes to pursue from the platform provided by its recent £10m purchase of Vocare Ltd.

This rather gives the lie to the Kings Fund assertion that "there are limited opportunities for private providers to generate profits." This shows a complete lack of awareness (or wilful blindness) regarding current private provision in the NHS. Virgin Healthcare has made a reported loss since it took over NHS community services, yet continues to bid for, and win, contracts. Its reported losses may be no more than an accountancy device as part of its complex structure of offshore companies that allow it to avoid paying UK taxes. This would bear examination. Likewise, Centene, United Health, multi-billion dollar multinational organisations, are more than capable, and willing, to bear short-term losses to gain an NHS foothold.

It also ignores the fact that the business model for Accountable Care Organisations is based on the USA’s Medicare/Medicaid system, and the incentives for cherrypicking patients that are built into its “managed care”. Centene has rapidly grown rich on this business model, to the extent that it is now seeking to expand into the EU and South American and is gaining footholds in Eastern Europe, Spain and the UK as well as South American countries.

The Kings Fund argues that "capabilities to deliver services do not exist among the private providers currently working within the NHS" This is no impediment. Historically, Virgin had no health service capability. In any case, private providers could takeover NHS services, TUPE staff across, and import their own management. Following its purchase of Vocare Ltd, this is exactly what Totally Ltd is doing, advertising for a Medical Director. And what about the capabilities of private providers who are not currently working within the NHS, but see Accountable Care Organisations and their monopoly control of an entire local NHS and social care system as another, even more “massive market opportunity”?

Finally, the Kings Fund recognises that the AC contracts will be subject to a "bidding process." However, presumably as the Kings Fund has little experience of the bidding processes, the point is that when you open a bidding process you can't control the outcome. Private providers, almost without exception, will bid low to win contracts (see Carillion) and gain market-entry.

All of which provokes the question...

Why is the Kings Fund so enamoured with accountable care?

It is for others to enquire into the relationships between the Kings Fund (and other think-tanks) with the private companies whose interests they so assiduously promote; how the ideas about accountable care have been transported into NHS policy development; and why NHS management is in thrall to “policy gurus” such as Chris Ham.

Pending such an inquiry, it is worrying to see the Kings Fund misleading and biased information presented in what should be an impartial Parliamentary briefing on Accountable Care Organisations.

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