Oxfordshire STP barrels ahead to become Accountable Care System as Judge rules split STP consultation was lawful

Politicians and public are fighting hard to save Horton Hospital after a Judge ruled on December 22nd that the contentious split consultation on the Oxfordshire Sustainability and Transformation Plan was lawful.

This followed a Judicial Review of the lawfulness or not of the STP-related public consultation about the downgrade of Horton Hospital and centralisation of acute hospital services, which ended on Friday 8th Dec, with the Judge reserving judgement until he had considered the evidence and arguments presented in court.

The big issue for the four councils and the Keep the Horton General group, which brought the Judicial Review, was that the Clinical Commissioning Group (CCG) split the consultation on the STP proposals into two phases, and so effectively predetermined the second phase of the consultation.

Although the Judge ruled in favour of Oxfordshire CCG, his ruling was very critical of their consultation. In Paragraph 25 he stated:

“The conclusions I have reached thus far should not be taken to signify that I personally approve of the decision to split this consultation. It was said that the reason it was done in this way was because of the urgency of the matters covered by phase 1. But they were not urgent.”

In Paragraph 26 he said:

“I can well see why in the absence of hard data the claimants and the interested party would assert that as a matter of principle decisions made following phase 1 would queer the pitch when the phase 2 consultation came around…It is a mystery to me why that data was not supplied sooner.”

The hard data held by the CCG only emerged in the Judicial Review. North Oxfordshire MP Victoria Prentis stated:

“The judgment has simply served to reinforce my profound discomfort about the way in which the CCG ran the consultation. I have written to the Secretary of State immediately, urging him to use the powers identified by Mr Justice Mostyn, which enable him to ask the CCG to rerun the consultation.”

This is an issue about a nationwide change in the way the NHS is planned, not just about the Horton. The government’s fragmentation and downgrade of the entire NHS into Sustainability and Transformation Partnerships – many of which are already preparing to become Accountable Care Systems – has presented the Oxford University Hospitals Trust with what they always wanted, the centralisation of all acute services in Oxfordshire at Headington.

However this is being fought by local Councils and NHS campaigners. After the Oxfordshire Clinical Commissioning Group (CCG) resolved in August 2017 to make permanent the temporary suspension of consultant-led maternity at the Horton General Hospital, the Joint Health Overview and Scrutiny Committee referred the matter to Secretary of State for Health, Jeremy Hunt.

Local Councils in the STP area then brought the Judicial Review, with Save Horton Hospital as an interested party.

Campaigners in Banbury put many hours, days, weeks and months into efforts to stop the unfair justifications for taking acute services away from a district general hospital that provides 170,000 – 250,000 people in its catchment with vital, acute services.

They have given as much of their expertise, knowledge and evidence as they could given the time (and other) restrictions imposed.

Independent Reconfiguration Panel to investigate the maternity unit’s permanent downgrade

Following the Judicial Review, the Secretary of State has referred the permanent downgrade of Banbury’s maternity unit to the Independent Reconfiguration Panel (IRP).

Ten years ago the IRP carried out a full investigation into proposals to take away consultant -led maternity services from Horton General and ordered that this should not go ahead.
Keep the Horton General Chairman, Keith Strangwood, said:

“We are delighted by the Secretary of State’s decision. George Parish and Tony Baldry fought such a hard battle 2006-8 to retain the full services of a District General hospital. We firmly believe the decision made by the Independent Reconfiguration Panel then will stand firm in 2018.”

Victoria Prentis MP stated,

“The IRP is the independent expert on NHS service change; it takes into account all available evidence in order to advise the Secretary of State on contested proposals. I have no doubt that they will look at this matter properly, and am hopeful that they will agree to undertake a full investigation.”

Cllr Kieron Mallon, a longstanding Banbury Councillor and campaigner for the Horton also commented:

“For those of us who were involved in 2008 we think it is right and proper for the Secretary of State to refer this on. We are all hopeful that the Independent Reconfiguration Panel will investigate this fully as they did the previous referral.”

The Oxfordshire STP is part of the wider Berkshire Oxfordshire and Buckinghamshire “footprint” STP

Buckinghamshire STP is on NHS England’s list to become one of the first eight NHS Accountable Care Systems. These are being set up across the country to go live in April 2018.

Accountable Care Systems are a midway step on the road to becoming Accountable Care Organisations, and these early ACSs are intended to pave the way for other STPs.

999 Call for the NHS is bringing a Judicial Review against NHS England’s draft Accountable Care Organisation contract, which they and lawyers Leigh Day believe is unlawful. The case will be heard in Leeds on April 24. The campaign group is currently appealing for funds through the CrowdJustice site to covert the costs of the Judicial Review.

A group of Eminent Health Professionals has also lodged a claim for Judicial Review against the Sec of State for Health, on the grounds that he is trying to change some regulations to enable Accountable Care Organisations to be set up, without bringing these proposed regulatory changes before Parliament for our MPs and Peers to debate and decide on and before any public consultation has taken place.

Oddly enough, the Sec of State has not included the Health and Social Care Act 2012 in his proposed regulatory changes – although NHS England’s draft Accountable Care Organisation contract would be unlawful under this Act – which is the grounds for the 999 Call for the NHS Judicial Review.

Accountable Care Organisations are a new form of public/private local organisations for health and social care that are based on a business model used by the USA’s Medicare/Medicaid programme, that provides a limited range of care for people who are too poor to pay for private health insurance.

If set up, they would

  • threaten the core NHS principle of access to the full range of healthcare for all who need it, through restricting access to elective treatments such as cataract removals, hip and knee replacements etc
    •hasten 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 an area’s NHS and social care services.

If your ST Partnership plans to become an Accountable Care System, please let us know. NHS protectors across England have already identified over 30.

Oxfordshire Clinical Commissioning Group’s new interim CEO is also the CO of Aylesbury Vale and NHS Chiltern CCGs in Buckinghamshire

Oxfordshire Clinical Commissioning Group has just appointed Louise Patten as interim chief executive officer (CEO), and she started work on 1 January 2018.

The CCG said that they appointed her because they need a “ system leadership approach” and while Ms Patten will remain as Accountable Officer in Buckinghamshire she will to help “develop the Oxfordshire system working”.

She has led the successful Buckinghamshire application to become one of the first eight NHS Accountable Care Systems.

The Oxford CCG press release quotes Ms Patten as saying:

“I hope the experience I bring in leading one of the first Accountable Care Systems will enhance the plans for transforming health and social care services in Oxfordshire.”

Dr Kiren Collison, clinical chair of Oxfordshire CCG, said:

“Louise will bring a wealth of experience which will help Oxfordshire drive forward its plans for more collaborative working between health and social care providers.”

In other words, Ms Patten has been employed by Oxforshire CCG in order to drive the development of an Oxfordshire Accountable Care System.


  1. Dear 999,

    NEL STP (now ELHCP) intends to implement ACS governance structure from Feb 2018, when Hunt “lays the regulations” but before Health Select Committee reports or legislation has been passed. Although NELSTP will say they have consulted, public meetings were engagement not consultation.

    I attach a copy of the email from the STP leader, now Single Accountable Officer, informing of the new structure. Although the City and Hackney CCG eventually agreed to sign up to the SAO, the C+H CCG Chair told me that she had been directly threatened by NHSE that – if they did not sign up – C+H CCG would be put under legal directions by NHSE, resulting in NHSE staff appointing themselves to run the CCG. This measure is stated in the 5YFV Next Steps document as a means to overcome objection to NHSE’s plans.

    Thanks for all you do.


    Sent from Mail for Windows 10


    • Thanks for this info Nick. You attached email doesn’t seem to have come through so if it’s ok I’ll email you and then you’ll have my email address to send it to. We have heard exactly the same comment from our CCG Governing Body about the threat of NHSE taking over the CCG when we’ve asked them to refrain from doing things that would damage local services. So much for the much trumpeted autonomy of local clinicians who know best what their patients and general public need, which our Tory MP has repeatedly claimed whenever we’ve protested at cuts and closures.


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