Jeremy Hunt is in the middle of an enormous stealth-reorganisation of the NHS into ACOs (accountable care organisations), modelled along the lines of the hugely inefficient US healthcare system. According to healthcare experts:
- Like Sustainability and Transformation Partnerships, the introduction of Accountable Care Organisations is being done in replacement of a single, English NHS, with the loss of all national risk pooling and finance pooling.
- ACOs are designed to not automatically serve everyone in a given area, the way the NHS would have done. E.g.: They are only obliged to deal with individuals who are registered with them.
- They have artificially restricted, pre-set budgets that are cut so as not to cover all of people’s healthcare needs, the way the NHS otherwise would have done. This means people will be denied care, which the 2012 Health and Social Care Act laid the groundwork for by removing the state’s duty to provide comprehensive healthcare to the population.
- ACOs are set up so that all the services can be outsourced to a single private company, or to a shell company which can include all sorts of players, from a GP consortium, to a private healthcare multinational, which can outsource, even to an NHS body.
- Even to the extent they are in the hands of public bodies, ACOs are designed to end the basic NHS principles of comprehensive healthcare for all. These founding NHS principles recently found extraordinary support among the population, around the 90% mark. No government has ever had a mandate to dismantle our access to healthcare in this way, let alone in blatant avoidance of parliamentary scrutiny.
The nature and consequences of the reorganisation are so damaging that leading health experts are going to court to try to stop it, but the issues with ACOs will be a mystery to a majority of the public.
Some of the key problems and concerns with the system – apart from the obvious increased privatisation almost certain to ensure – are laid out in these questions, which have been sent to the Dept of Health (DH):
- What is to stop a large private company tendering for an entire ACO and then sub contracting out the various functions?
- What will be the legal basis of the NHS parties to the contracts involved?
- To whom will the CEO of an ACO be accountable and how – i.e. what forms of accountability will exist?
- What happens to the legal responsibilities of CCGs involved within the footprint of an ACO?
- Who will employ the staff contracted to provide services by the ACO?
- Will ACOs be able to use the prime and subcontractor contractor model in procuring services outside hospital trusts and general practices?
- If so what prime contractors will be eligible to be used?
- Will private providers who have been convicted of, or agreed settlements when accused of, fraud be eligible to be used?
- Will all providers of services commissioned by ACOs be fully subject to the Health Service Ombudsman and the Freedom of Information Act?
Hunt’s new structure appears designed to be opaque, unaccountable and confusing for the public – campaigners say this is deliberate in order to facilitate privatisation without public awareness.
The DH’s responses to the question above will either shed light on the risks of the system – or confirm that Jeremy Hunt and his party want to keep the public in the dark about this massive ‘top-down reorganisation.
But given the tendency of Jeremy Hunt to run and hide from awkward questions, don’t hold your breath.
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