12th March 2018
We think it might be. At least we're seeing all the signs from a number of Sustainable & Transformation Partnerships as well as from Ben Bradshaw MP, who said as much to Jeremy Hunt in the first session of the
27 February Health & Social Care Select Committee meeting.
Kernow Clinical Commissioning Group, as well as NHS organisations and Councils in Devon, Northumberland, Greater Manchester and Dudley have all announced that they are rowing back from setting up Accountable Care Organisations, opting instead for other informal means of setting up Accountable Care models.
We urgently need to know what practical difference - if any - that is going to make to NHS, social care and public health cuts and privatisation.
The latest news of a move to ditch the Accountable Care Organisation route map comes from Devon.
Seems a good place to start...
Devon’s CCGs have recently made a public statement that, in introducing an Accountable Care System (now rebranded by NHS England as an Integrated Care System!) they are not going down the road of an Accountable Care Organisation.
Taken at face value, it looks as if the CCGs have binned the South West Academic Health Science Network’s “route map” to a Devon Accountable Care Organisation - despite the fact that this was endorsed last December by Dr Tim Burke, the Chair of Northern, Eastern and Western Devon CCG.
Accountable Care Systems are described in the South West Academic Health Science Network paper as an “informal approach” where “no legal entity” is established and “contracting is still bi-lateral between commissioners and individual providers.”
Devon CCGs and Devon County Council now need to define exactly how and whether the Accountable/Intergated Care System will differ from the proposed Accountable Care Organisation, in terms of what it DOES to NHS, social care and public health services - as distinct from the fact that it operates through an “informal approach.”
Presumably it will not mean any rowing back from Accountable Care methods. These include four types of integration (spelled out in NHS England’s 5 Year Forward View as: mental and physical health, health and social care, primary and secondary care, and prevention and treatment).
Those words belong to Chris Ham when he was Director of the Strategy Unit at the Dept of Health in 1997. And the right hand man of the then Health Secretary - Frank Dobson.
Still think "Integration sounds like a good thing? Even when you hear these words? Read more of Chris Ham's speech and wonder as to the nature of his work at the Kings Fund as Chief Executive.
The NHS was integrated until 2004, when the New Labour government confirmed - semi- covertly but officially - that the NHS democratically accountable public service was to be replaced by a full healthcare market.
In a single statement to the HoC that lasted 1 hour and 12 mins with minimal debate, the Health Sec John Reid pronounced what Prof Allyson Pollock described as the New Labour government’s "death sentence on Atlee's and Bevan's NHS". Chris Ham commented:
'...We are shifting away from an integrated system in which the NHS provided virtually all the care to a much more mixed one in which the private sector will play an increasingly major part - first of all in hospital care and diagnostics and probably, in time, other kinds of of care from chronic conditions to what has traditionally been seen as family doctor services...The government has started down a road that will see the NHS becoming increasingly a health insurer that provides the funds but ...the private sector will become a big provider."
(Allyson Pollock, NHS plc p238-239)
Now in 2018 Accountable Care Systems have been rebranded as Integrated Care Systems, in an attempt to disguise our rapid approach to the end of the road where the NHS becomes a health insurer that provides the funds, increasingly to the private sector.
Page 23 of the South West Academic Health Science Network paper seems to suggest that an Accountable Care Organisation isn’t needed for integrated commissioning that operates through an integrated contract:
“A decision to include a budget in an integrated commissioning arrangement would, as a minimum, mean that the population outcomes framework guiding the integrated function would take into account the outcomes expected from that budget. It need not mean that it was part of a joint procurement approach or integrated contract.”
“a massive market opportunity” for privatised out-of-hospital care
The South West Academic Health Science Network paper says Accountable Care methods also include: ‘accelerating the implementation of electronic care records and the use of predictive tools to identify patients who have higher than average healthcare costs’.
This aims at reducing acute and emergency hospital admissions of patients with long term illnesses and speeding up discharge from hospital. In turn, these methods are used to justify cuts to hospital beds and services.
The resulting increase in under-resourced out-of-hospital care - previously called Care Closer To Home - is creating what Totally Ltd has called “a massive market opportunity” for private healthcare companies.
Instead of pussy footing around and issuing gnomic statements, Devon Sustainability & Transformation Partnership needs to spell out exactly what it intends to do as an Accountable Care System. What exactly is it?
You know the old saying... if it walks like a duck and quacks like a duck..
“an important player in the UK healthcare system,
with a growing range of healthcare services to offer improved care
for those whose conditions can be better treated at home, locally, or in the community.”
As well as the Devon CCGs’ rather vague public statement renouncing the creation of a Devon
Accountable Care Organisation a more direct disavowal of ACOs was made in a statement to the
Devon County Council meeting on 15th February, by Cllr Andrew Leadbetter, Cabinet Member
for Social Care and Health, with the evident collaboration of the NHS.
This paper, 'What is an Accountable Care System?', which curiously was issued only on paper at the meeting, not electronically, states:
'A few areas in England are on their way to establishing an Accountable Care Organisation (ACO), where a single organisation is responsible for planning and delivering services to the whole population. This is not being considered in Devon.'
However, it no longer seems to be the case that a few areas are on their way to establishing Accountable Care Organisations. Manchester and Dudley Accountable Care Systems have delayed signing the Accountable Care Organisation Contract.
A Northumberland Council Cabinet paper recommends continuing to integrate NHS and social care through existing section 75 partnerships, rather than setting up an Accountable Care Organisation, since:
“The original plans for the ACO are not now proceeding. Discussions are ongoing with NHS England, NHS Improvement and local system leaders about how organisational relationships might now develop to support the integration of services, however the timetable for and nature of any new arrangements remains unclear...”
And there is: “uncertainty about longer term developments in the NHS...it now seems clear that no ACOs will be created nationally in the near future, as a result in a shift of national policy."
Presumably this is because the Accountable Care Organisation
contract is due for public consultation, at some unspecified date.
Are we lost?
Does anyone know where we are on the map?
Or are we best to dump it in the bin?