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By Steve Carne, 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


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.”



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

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