By Steve Carne, Apr 23 2018 06:00PM
Joanne Land reflects on the way to Leeds.
It’s the night before 999’s day in court. As you read this I'm on a train to Leeds to join the team bringing a Judicial Review challenging NHS England's efforts to introduce Accountable/Integrated Care to the NHS.
Bringing a judicial review is a huge undertaking and it’s quite nerve wracking. We’ve had a great team working on this for almost two years, and I know that for various reasons, come Tuesday night, after a day in court, it will still not be over.
Aside from the legal team who have worked with us on this case, we are all volunteers. Full time volunteers, like so many campaigners these days it seems. We do this because we understand the worth of the NHS and want to safeguard it for future generations. There’s always an element of self interest when it comes to protecting the NHS though, as we all rely on it, and I had this brought home to me forcefully when I got pneumonia last month.
It’s amazing to think, as warm as it ihas been this last few days, that seven weeks ago there was snow on the ground! I slipped and fell on the ice and the next day, I went to the John Radcliffe Hospital in Oxford, as I feared that I had broken my ribs. By that time, I had begun to cough. The doctor examined me and determined that I had not broken my ribs, but rather than ignoring the cough, he sent me for a chest x-ray. This revealed that I had pneumonia. I was started on antibiotics the next day, and although I felt more ill than I had ever felt before in my life over the next week, within 6 weeks I had made a full recovery.
Imagine an NHS remodelled along US-style lines.
Would I have had my pneumonia diagnosed on the very first day of symptoms? Or might it have been missed, given that financial considerations will trump all other considerations? I realise the answer to that question is fundamentally unknowable. But one thing I do know is that if ACOs are allowed to be introduced to England’s NHS, ‘care pathways’ and financial considerations will be allowed to trump clinical judgement and patient need. How do I know? Because that is what happens in the US, where the ACO model hails from.
That’s why I’ve been doing what I can to alert people to the risk that Accountable Care will pose to our health, and to spread the word about our judicial review. Social media is great but it’s not a substitute for meeting people face to face. In February, I spoke about the Accountable Care threat at an NHS conference in Stroud, and also earlier this month at a three-day conference held by Ruskin College (where I’m a student) at Exeter College, Oxford.
The 999 Call #Justice4NHS judicial review can't and won’t actually be judged on whether we think ACOs are a good or bad idea (no hesitation on our part – they're a bad idea) – it will be judged on a very tightly focused point of law. Can NHS England introduce a contract with a new funding model (WPAP - Whole Population Annual Payment) that will radically alter the way in which the health service operates and functions? We don't think so.
THIS point of law
... this payment mechanism that NHS England want to introduce – is a crucial one when it comes to the harm that ACOs will do. Accountable Care organisations with their capitated budgets, will be financially based – not clinically based. Handing a lump sum at the beginning of an annual period to a single controller of health and social care (ACO/ICS whatever...) threatening them with fines for over spending and incentivising “efficiency savings” by letting them keep any money they don't spend... well you finish the sentence.
Accountable? To whom?
We like to say Accounts-able. Think Accountable as in accountants – not to patients. That’s why, whatever happens on Tuesday and the weeks and months after, we have to stop this threat to the NHS as a comprehensive healthservice for al of us who may need it at any time in our lives.
Our own health and the health of generations to come is in our hands.
And our hands are public hands.
Thanks to everyone who has helped us over the last year with donations and messages of support. We hope our day in court helps us all.