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999 Call for the NHS

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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.




By 999 Call for the NHS, Dec 28 2017 05:40PM


Another Christmas is over, the presents, the food, the snoozing in front the telly, no doubt a few family rows. Done and dusted.


As we edge towards another New Year and people are beginning to think about resolutions, new projects, new ideas, we're beginning to think about the symbolism of the turning of the calendar year with longer days of light ahead, dreams of Spring, new energy and that dangerous spirit of determination - HOPE


So where the hell is the HOPE?


Well... it lies in us, ordinary people putting ourselves back into politics with courage and determination to provide a healthier future for our children and generations ahead.


Hope lies in us gathering courage from each other to challenge the establishment and question the perverse Austerity logic of our elected representatives, the mechanisms of power, the media and big business. Drip down economics, tightening our belts cos we can't have what we can't afford... we can and will break that myth.


And here's believing that HOPE lies in our legal system. Because we are “marching” once more - this time to the High Courts to challenge NHS England. It seems sad and ironic that we are challenging the very institution that is supposed to be providing our healthcare. But we must and we need campaigners and public to march with us. We are challenging their decision to introduce an Accountable Care Organisation Contract which could allow USA style healthcare to end our NHS.


We're fighting through the courts because we believe the new contract will:


• threaten the core NHS principle of comprehensive healthcare for all who need it by restricting access to elective treatments - cataract removals, hip & knee ops etc.


• speed up the development of a two tier system where those with money pay to go private and the rest are left with a reduced NHS


• increase NHS privatisation, and potentially put private health companies in a position of control over local NHS and social care services.



Just 3 days before Christmas


Our lawyers, Leigh Day, contacted us with the news that a judge had considered our claimant papers and had (with little doubt it seems) seen the value of our legal arguments and granted permission for a full Judicial Review of the decision by NHS England to introduce their 'Draft' ACO Contract.


This was a genuine surprise. We'd been told that most likely any news would be after the festive holidays. But it's a welcome surprise genuinely filled with hope.  At some point, after February 16th 2018, a date will be set and 999 Call for the NHS will be standing opposite NHS England in the High Court .


Like many fellow campaigners, we firmly believe this ‘draft’ Accountable Care Organisation Contract radically changes the nature of the NHS. Strangely it's based on the USA Medicare/Medicaid system - globally recognised as the world's WORST healthcare system (expensive and rubbish!). Medicare only covers a limited basic menu of treatment leaving those who can afford it to pay for private healthcare and those who can't to go without.


What happened to the fundamental principles of providing a full comprehensive range of clinical care for everyone who needs it? The core of the once world-leading British National Health Service.


This Judicial Review is a huge Public Interest case


The judge obviously agreed because we were also granted a Capped Costs Order (CCO) which means,  if we lost, we would pay a fixed sum of £25,000 not the entire costs that NHSE could try to claim (they had temporarily successfully scared us with a threat of £170,000 and if we had not been granted the CCO we would have had to have pulled out).


We had fingers crossed that the judge would agree to the £15k we had already raised with the public's generosity but even though the CCO sum is £25k it shows that the judge has seen the merits of our case statements and we must take hope and courage from that. As a team we spent the day before Christmas Eve email-wrangling through the judge's decision. Could we afford another £12,000? Would the public join us in raising this extra money?


In the end it was a unanimous decision. Going to court, setting up another round of CrowdJustice fundraising was the only option on the table. We owe it ourselves, our fellow campaigners and the country.


"Hope lies in ordinary people putting themselves in extraordinary circumstances".


Well one of these extraordinary circumstances has arrived.


You can find out about the case on our Judicial Review page .


This case is for everyone. It affects all of us. We hope you can join us and help us.


LIKE and SHARE this blog. Tell your friends about the case and that we will be launching Stage 3 of our CrowdJustice fundraising appeal very soon.


Thank you.


Here's to Hope.





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