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By Jenny Shepherd, Jan 24 2018 08:29PM

Secretary of State says Tory whips have tied his hands over delay to ACO contract


Reports that Jeremy Hunt has paused the creation of the first Accountable Care Organisations appeared to be unfounded after his evasive replies to questions at the Health Select Committee meeting on 23rd January 2018.


However, NHS England’s announcement on the 25th January READ ALL ABOUT IT of a 12 week consultation on ACO contracts says that until this is over “No ACO contract will be awarded in the meantime.”


Why couldn’t Hunt, as Secretary of State for Health, just inform the Health Select Committee of this simple fact? Instead of playing absurd games.


On 18th January, the Chair of the Health Select Committee, Sarah Wollaston MP, wrote to Hunt asking him to delay the introduction of the draft Accountable Care Organisation contract until the Committee’s inquiry into Sustainability and Transformation Plans and Accountable Care Organisations was completed.

 

Hunt's reply to Wollaston's letter and his performance yesterday in her Health Select Committee (both are on Parliament website) are master classes in evasion and obfuscation.


His letter says:


• he expects NHS E to announce this week a consultation on the prototype ACO contract before it is used by any CCG.


• He anticipates that a few “sites” (ie STPartnerships) “could be in a position to sign an ACO contract later in 2018” - implying that they would not now be doing that for April 2018


• In the light of the HSC inquiry and the Judicial Review that has been brought against ACO policy, he is considering the timing of secondary legislation for regulations to enable piloting of the draft ACO contract, that he had planned for Parliament to pass in February



But...


in the Health Select Committee meeting (Monday 22nd Jan), Sarah Wollaston MP asked Hunt SIX TIMES to clarify the statement in his letter that he is considering the timing of secondary legislation for regulations to enable piloting of the draft ACO contract.


Hunt seemed either unable or unwilling to give a straight answer.   


First he avoided the question by saying that ACOs were not a vehicle for NHS privatisation, although he then admitted that a private company could lead an ACO, since he said the government is powerless to specify which type of body bids for NHS contracts.


Then Hunt tried to hide behind the Tory whips, saying that the timing of the regulations is really up to them.


Then Hunt claimed Brexit regulations were “going to take up pretty much all Parliamentary time when it comes to secondary legislation.”


His next gambit was to repeatedly (6 times) try to hide behind NHS England and its upcoming announcement that it will have a full public consultation into the new ACO contract.


He then said that the regulations could be passed, but they could be changed following NHSE’s consultation since “consultations can advise that regulations should be changed.”


Then he said he was “not necessarily saying regulations will be laid.”


Then he said “ We will listen to anything the Select Committee says, as we always do.” At which Wollaston laughed delightedly and asked no further questions.


Exeter MP Ben Bradshaw (Lab) promptly chipped in to ask Hunt if he didn’t regret using the term ACOs, since with its American connotations this was always going to be "a red rag" to the campaigners' "bull"?  Since good proportion of his Devon constituents are campaigning to stop the imposition of an ACO in Devon, this characterisation might not go down too well with them.


Bradshaw added that the ACO proposals are "sensible vertical and horizontal integration that could overcome the internal market and be very positive". At which point Hunt sat back for the first time in the meeting and smiled.


A more detailed summary of the Secretary of State's statements is downloadable in window on right.




Let’s be clear what ACOs are: new local NHS and Social Care organisations which are clearly based on the business model used by the USA’s Medicare/Medicaid system, where the state ONLY provides a limited range of “managed  care” to patients who are elderly or too poor or ill to afford private health insurance.


The NHS must continue to provide comprehensive healthcare to all who need it. But this is under threat from Accountable Care Organisations.


Our Judicial Review, to be heard in Leeds court on 24th April, challenges the lawfulness of the draft Accountable Care Organisation contract’s payment mechanism. 


Geared to meeting the £22bn+ funding shortfall by 2021 that the government is imposing on the NHS in England, the new ACO contract does not link payment to the number of patients treated and/or the complexity of the medical treatment they need, as is required by the 2012 Health and Social Care Act. Instead, payment would be based on a fixed budget for an area’s population.


The contract allows the Accountable Care Organisations to keep any unspent money left over at the end of the year, while also making them bear the risk of overspending.

 

This new payment mechanism is supposed to drive efficiency and incentivise Accountable Care Organisations to “manage demand”  for NHS and social care services, but we are concerned that financial decisions not clinical need would determine patients’ access to treatment.


This is what’s happened in other countries, where Accountable Care Organisations have cherry-picked treatments and patients that represent “good value for money”,  while failing to comprehensively meet patients’ clinical needs.


Steve Carne, one of the 999 Call for the NHS core Judicial Review team, said,


“We were really hoping that the Secretary of State would do the sensible thing and pause the introduction of the Accountable Care Organisation contract, as the Chair of the Health Select Committee requested.

We are puzzled and disappointed by his prevarication to the Health Select Committee. What can possibly be gained by sowing further confusion about the complex and contentious introduction of these new local forms of NHS and social care organisation?

We look forward to bringing our Judicial Review to Leeds Court on April 24th, which will begin to establish some clarity whatever its outcome.”


LETTERS BETWEEN WOLLASTON AND HUNT ARE HERE: http://bit.ly/WOLLASTONHUNT


THE VIDEO OF HUNT AT HEALTH SELECT COMMITTEE: SEE VIDEO


UPDATE NOTE: 25th January 2018. We've updated the blog with the news of NHS ENgland's upcoming consultatoin on Accountable Care Organisations

By Jenny Shepherd, Jul 26 2016 08:08PM


Is it SAFE?
Is it SAFE?

I've just spent the best part of 2 hours laid flat on my back with my mouth forced wide open with plastic and metal while the dentist drilled, sprayed and drilled repeatedly to complete the dreaded minor surgery that is the Root Canal. It's fairly hideous. First the injection to numb, then the pick, then the drill. Drills. Slow sledgehammer to ultra-thin needles to scrape and purge the nerve. 45mins of NHS torture which will cost me £53.80. Bargain.


But it's not over. Disinfectant which lets the back of your throat know what the toilet bowl feels being sprayed by Harpic. Finally the filling and the joy of prepping the tooth for a crown. Irony. You drill for 45mins. Fill the hole. Then drill again!


What's all this got to do with the NHS I hear you ask? Well... as an NHS patient I had to decide what quality of crown i wanted - or rather which grade of crown I thought was worth paying for. A standard NHS crown was £200. I didnt go into great detail but that basically would be a strong but incredibly ugly piece of metal. The slightly better one was £400 and this would have been very strong and durable but not white. Then the final option - the "best" - was the £500 Zirconium ( i think I cant honestly remember because I'm still reeling at the price three weeks after being told) which is strong and made to match the colour of your own teeth.


Throughout the whole ordeal of bleach and burning enamel


I was thinking long and hard about the nature of the NHS we could lose and find ourselves lumbered with. The menu for treatment is a reality we have all gotten used to with the dentist. And it will become that way with NHS clinical treatment too. We won't lose the blue logo or the idea of the NHS but we will lose the "comprehensive and universal" element. It wont cover all emergencies and it won't cover everyone - just those who can afford to pay.


You'll turn up at A&E, or your consultant appointment and you will presented with a menu of options - Patient Choice no doubt will be the branding - and you will have to select what you think you can manage to cope with financially. Don't worry if you're not prepared with insurance or a fat bank balance - the basic will still be paid for by the general tax payer community. The basic cover. If you want a nice finish or a comfortable bed with breakfast and decent follow up care you might just need to go for the top-up options.


It has to be this way because the new model of NHS being imposed on us now by NHS England and NHS Improvement (love that name) needs to keep the internal market in control of our NHS. It has to be Sustainable you see... find out about Sustainability


How else are private providers going to keep increasing profits year after year?


In the USA the medical insurance profession has produced a system that gives them the most profit. Obamacare and Medicare cover the basics of healthcare - even then you really have to fight for it - and then if you can afford it you can pay dividends, top-up fees. It's a "pay-as-you-go-if-you-can" system. And, to use the American venacular, it SUCKS!


According to Investopedia : A study done at Harvard University indicates that this is the biggest cause of bankruptcy, representing 62% of all personal bankruptcies. One of the interesting caveats of this study shows that 78% of filers had some form of health insurance, thus bucking the myth that medical bills affect only the uninsured.


Read more: Top 5 Reasons Why People Go Bankrupt | Investopedia http://www.investopedia.com/slide-show/top-5-reasons-why-people-go-bankrupt/#ixzz4FXWecRym


This makes even worse reading : CBNC REPORT



Here in the UK the government know it would be political suicide if they declared an end to the NHS. So it's safer to keep the blue logo flying. Safer to disguise the layers of "pay-if-you-can" and pretend it is still the NHS that is the public's head - free at the point of use unless you want "the best". But if you watch and listen carefully they are telling us. It's coming to the end.


Jeremy Hunt in this video (courtesy of our friends KOSHH): Keep Our St Helier Hospital


And Sir Bruce Keogh, NHS MEDICAL DIRECTOR, in his Report on Urgent Care said: "We already have a two tier system and all we (NHS England) are doing is formalising that and bringing an inconvenient truth to the attention of the public". LINK


But the reality is, as NHS campaigner's are fully aware, we could lose everything that is caring about our NHS. The ability to provide what was once the world's best healthcare, the best medical training of nurses, doctors and clinical staff, the best research, the best influence and control on the mammoth financial monster that is the pharmaceutical drug industry.


If you can understand how the system works for the dentist you'll understand where the new NHS is heading. NHS Basic, NHS Better, NHS Best. Depending on what you think you can afford.


Oh... I'm lucky. I have a credit card. I chose the best. I'll be paying for it for the next six months.


But we can stop it. We need the Best NHS - an world-class institution founded once more according to Bevan's vision of a society caring for its citizens' health. A return to a fully public NHS - funded by us, run by us and accountable to us - can only happen if we pressurise our MPs to act out our wishes.


And this is why we need more fighters. Find a campaign group near you, talk to your friends, your neighbours, your workmates. Together the public really could make a difference. The best difference.


FIND A CAMPAIGN GROUP




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