The House of Commons has produced a Briefing on Accountable Care Organisations (ACOs).
House of Commons briefings tend to be even handed. This one is not. There is a bias in favour of NHS England’s 5 Year Forward View – which is the basis for the imposition of Accountable Care Organisations on the NHS in England.
This blog post looks at how corporations have gained control of health policy making, and asks whether this has anything to do with the omnishambles surrounding the development of Accountable Care Organisations.
A linked critique outlines the House of Commons Briefing’s failure to examine the Secretary of State’s endorsement of Kaiser Permanente and Ribera Salud, and explains how Accountable Care is based on an insurance model that puts money ahead of patients’ needs.
Accountable Care Organisations – another omnishambles in the making
The lack of clarity in the Department of Health and its quango NHS England about Accountable Care Organisations is indicated by the fact that the Briefing relies on the Kings Fund think tank for a summary of the core features of Accountable Care Organisations.
However the Kings Fund is far from impartial in its views on Accountable Care Organisations and their variants, Accountable Care Systems and Partnerships.
A US a sub-prime health insurance profiteer has wormed its way into the NHS through a UK holding company with the same address as the Kings Fund
Centene Corporation, a US sub-prime health insurance profiteer which in 2017 won a contract to set up Greater Nottingham Accountable Care System, has wormed its way into the NHS through a UK holding company, Centene UK, with the same address as the Kings Fund.
Centene UK, registered at Companies House as a business carrying out “Activities of other holding companies not elsewhere classified”, was set up in Feb 2016.
In 2016, according to Greater Nottingham accountable care system lead, Dr Stephen Shortt, Centene UK worked with Greater Nottingham STP:
“to identify ways that the different health and care organisations in Greater Nottingham could be brought together.”
Centene UK’s three directors are listed on Companies House website as all having addresses in St Louis, Missouri – the HQ of Centene. The address of one of the directors, whose occupation is listed on Companies House as “Svp, Controller, Chief Accounting Officer” is the Centene St Louis address. The two other directors previously worked for other Centene subsidiaries.
I had to look up what a “holding company” is – here’s a definition from the Global Negotiator website:
“Holding companies are corporations that are created for the sole purpose of obtaining and managing a controlling interest in other companies.”
The King’s Fund connection
Centene UK’s registered office is at 11-13 Cavendish Square, W1G 0AN – the same as the Kings Fund. In fact, according to a reliable source of information, their registered office is a rented room (with no phone) at the Kings Fund (according to the KF receptionist).
Just as Centene UK has wormed its way into the NHS, so its US parent company wormed itself into the Spanish state-funded healthcare system through the acquisition of 50% of Ribera Salud – a company and model of health care which the Kings Fund has consistently promoted over the years despite its massive flaws and failings which have been swept under the carpet in the UK.
Greater Nottingham accountable care system lead, Dr Stephen Shortt, implicitly referred to the Kings Fund support for Ribera Salud, (calling the company a “public sector ACS”), when he said:
“Centene UK has the experience of setting up Accountable Care Systems internationally. Like the public sector ACS in Spain (details published by Kings Fund here)”
Buyer beware. The buyer of Centene UK as the company to set up the Greater Nottingham Accountable Care System, is us – the public. We need to be like Madrid, where health service Trade Unions and health service campaigners kicked out the Alzira health service model developed by “the public sector ACS” extolled by Dr Stephen Shortt – precipitating the resignation of the Health Secretary.
Instead, the House of Commons Briefing on Accountable Care Organisations and the Health Select Committee Chair Sarah Wollaston MP are softening up both Parliament and public to believe the NHS and social care integration gospel according to the Kings Fund – promoter of Centene’s Spanish subsidiary Ribera Salud and its Alzira model.
On 21st Jan 2018, Sarah Wollaston MP urged the twitterverse to acquaint itself about Accountable Care Organisations and their variants through “a good explainer from @TheKingsFund” – which the supposedly unbiased House of Commons Briefing on Accountable Care Organisations also quotes.
At a Kings Fund breakfast event on 19 October 2017 to assess the prospects for health and social care under the minority government, Sarah Wollaston MP also endorsed the Kings Fund/Barker Commission on the integration of NHS and social care, making this central to her agenda for:
- a cross party consensus on NHS and social care;
- a driving role for cross party select committees – particularly a new Liaison select committee, when set up;
- no major NHS and social care legislation;
- secondary legislation to put Sustainability and Transformation Partnerships on statutory footing.
Secondary legislation is when the government introduces new laws and regulations without putting it before Parliament for the normal process of debate and scrutiny. This is how Jeremy Hunt wants to pass legislation to make it possible to set up Accountable Care Organisations/Systems/Partnerships.
Kings Fund and other think tanks share and promote the view of international corporations
In his recent article, already mentioned above, Stewart Player criticises the reliance of the House of Lords Committee on NHS Sustainability on information from the Kings Fund and other think-tanks that share the world view of international corporations His article provides evidence that,
“…the NHS has come under a sustained offensive from the transnational class. It’s important to note that the business fraction of this class will largely absent itself from overt decision-making channels… to continue the guise of accountability and neutrality. But within such channels the influence of this fraction is pervasive, and the consensus or ‘sustainable settlement’ sought by its supporters is entirely in its favour.”
Such consensus places little importance on the needs of the public. In quoting the Health Minister Steve Brine’s statement that Clinical Commissioning Groups are responsible for determining whether to commission an Accountable Care Organisation for their area, the Briefing omits to mention that this was in response to a Parliamentary Question, by Caroline Lucas MP. She asked about safeguards to protect comprehensive healthcare for all, to make sure that the new model Accountable Care Organisation contract would not result in fewer NHS services being provided than under the NHS standard contract. Steve Brine MP’s evasive reply did not in any way address the question; the Briefing passes over the Minister’s evasion and so appears to condone it.
The Briefing does, however, point out an apparent contradiction between the government’s statement that Clinical Commissioning Groups are responsible for determining whether or not to commission an Accountable Care Organisation, based on its appropriateness for their area, and NHS England’s statement that it has already determined which advanced Sustainability and Transformation Partnerships are to become Accountable Care Systems (which can later become Accountable Care Organisations).
This confusion is worsened by the fact that NHS England has named 8 Sustainability and Transformation Partnerships that are due to be fast tracked to become Accountable Care Systems /Accountable Care Organisations in April 2018 (with others like Cornwall as “fast followers”) – while campaigners have identified 30+ areas that intend to become Accountable Care Systems either by April 2018 or 2019. This vital information is missing from the House of Commons Briefing.
Given the sense of chaos surrounding Accountable Care Organisations, it is not surprising that the Chair of the Health Select Committee, Sarah Wollaston MP, has asked the Secretary of State for Health and Social Care to delay the introduction of the Accountable Care Organisation contract.
How was the House of Commons Briefing on ACOs prepared?
Since the House of Commons Briefing on Accountable Care Organisations is disappointingly partial when it should be even handed, we should be asking how it was prepared.
What has been the role, if any, of two All Party Parliamentary Groups : the All Party Parliamentary Group on Health, and the All Party Parliamentary Group on Global Health?
All Party Parliamentary Groups are informal cross-party groups that have no official status within Parliament. They are run by and for Members of the Commons and Lords, though many choose to involve individuals and organisations from outside Parliament in their administration and activities.
Stewart Player’s recent Open Democracy article points out that the All Party Parliamentary Group on Health is “recognised as one of the preferred sources of information on health in Parliament”. He adds that the group:
“claims it ‘is dedicated to disseminating knowledge, generating debate and facilitating engagement with health issues amongst Members of both Houses of Parliament’. The Group also ‘comprises members of all political parties, it provides information with balance and impartiality and it focuses on local as well as national health issues. It is recognised as one of the preferred sources of information on health in Parliament’.”
“The APPG on Health’s current website states that it ‘is supported by an Associate Membership of 14 of the UK’s leading organisations working in the health sector’. This is misleading. Business affiliates from the past few years include the large conglomerates Abbott, Bristol Myers, Novartis, Merck, Takeda, Pfizer, Optum, Sanofi, and Novo Nordisk. These companies were present at both the W[orld] E[conomic] F[orum]’s reports, some in both the Steering and Working Groups, as well as being heavily represented in the stakeholder forums.
The APPG on Global Health on the other hand has a somewhat smaller corporate membership, though this does include the Bill Gates Foundation. Its members however number Lord Darzi, as well as the Lords Ribeiro and Kakkar who were among the dozen core members of the Lords inquiry, as well as its Chairman, Lord Patel.”
Campaigners’ Judicial Reviews
The House of Commons Briefing quotes the Health Service Journal’s ‘predictions’ for 2018 which say that campaigners’ biggest success will likely be a change of name for the ACOs which will break the association with the US model. This is to underestimate and misrepresent campaigners’ intentions – we are not quibbling about semantics.
This must be clear to whoever wrote the House of Commons briefing, since its last section does report on the two Judicial Reviews that campaign groups have brought to challenge Accountable Care Organisations
A group of doctors and academics is bringing a Judicial Review against the Secretary of State, on grounds that include his arrogation of the power to allow Accountable Care Organisations to exercise delegated Clinical Commissioning Group responsibilities for allocating resources and designing health care for its population, as well as his failure to consult on both the proposed introduction of Accountable Care Organisations, and the draft Accountable Care Organisation contract.
999 Call for the NHS’s Judicial Review of NHS England’s Accountable Care Organisation contract is due to be heard in Leeds on April 24th. The grounds for our Judicial Review are that the Accountable Care Organisation contract’s payment mechanism is unlawful under current NHS legislation.
In giving permission for this Judicial Review, a judge has stated that this will be the sole focus of the Judicial Review, which will not consider the merits or demerits of Accountable Care Organisations.
Thank you to Deborah Harrington for contributions.
Updated 22 January with information about the Kings Fund connection with Centene UK