Integration: “alternative terminology… for…market focussed imports from the US”

NHS England has decided not to talk about Accountable Care any longer, because of its pesky connotations of USA health companies and Medicaid/Medicare. Instead we are to call Accountable Care, Integrated Care.

Integration sounds like a good thing. Which is no doubt the point. But bear in mind Chris Ham’s 1997 promotion of  “integrated care” as

“alternative terminology… for the key principles of managed care”

in order to avoid

“negative impressions of market-focused imports from the US…”

This was in the third issue of the Journal of Managed Care, from May 1997, just after New Labour swept to power. It reported on a symposium from the University of Birmingham. Among the contributions from consultants, managers and BUPA reps, Chris Ham, now Chief Executive of the Kings Fund, warned the delegates of the

“potentially unhelpful language surrounding US managed care”.

His 1997 BMJ article on Primary managed care in Europe spells out many of the changes that are now being imposed by Sustainability and Transformation Partnerships/ Accountable Care Systems. It has clearly been a long game.

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 House of Commons with minimal debate,  the Health Sec John Reid pronounced what Prof Allyson Pollock’s book NHS plc describes as the New Labour government’s

“death sentence on Atlee’s and Bevan’s NHS”.

At the time, Professor Chris Ham – now the Kings Fund Chief Executive – was Director of the Strategy unit at the Department of Health, and the Health Secretary’s right hand man. He 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.

Update 15 May 2021

Chris Ham is now Co-Chair of the NHS Assembly, Chair of the Coventry and Warwickshire Health and Care Partnership, non-executive director of the Royal Free London Hospitals NHS Foundation Trust and an expert adviser to Carnall Farrar.

Update Feb 2022

In a 2022 report commissioned by the NHS Confederation – a membership organisation for NHS and private health care providers – and supported by the US spy tech company Palantir, Chris Ham claimed Palantir has been crucial to the success of the rollout of the Covid-19 vaccination in England. He promotes the notion that it was it was Palantir’s Foundry system and the British Army that were responsible for the success of the Covid-19 vaccination programme. 

The NHS Confederation/Palantir sponsored report, “Governing the health and care system in England – Creating conditions for success”, seems to propose that reliance on Palantir-engineered big data, together with organisational reform modelled on the US army’s reorganisation in response to terrorism,  are to define the future NHS, as run by statutory Integrated Care Systems once the Health and Care Bill becomes law.

Update 1 October 2022

Chris Ham has published an opinion piece in the British Medical Journal bemoaning the new Truss government’s plan for the NHS and mini-budget, and slyly advocating a return to New Labour “third way” policies

He gets off to a punchy start, observing that,

“many commentators… suggest that there is no early prospect of resolving what amounts to a humanitarian crisis affecting patients waiting for an ambulance or admission to a hospital bed, or at the end of a long queue for investigation and treatment.”

His BMJ opinion piece proceeds,

“In exhibiting wilful blindness, the government risks fundamentally damaging services to the point where the very sustainability of the NHS is brought into doubt. The political crisis in the NHS may not be new but it has taken an acute form in the hands of a government with, as yet, limited understanding of the realities of the NHS and social care. If the prime minister and her chancellor have their sights set on the next election, they would do well to remember that the public’s attachment to the NHS remains strong notwithstanding the difficulties it faces.”

“As winter approaches, the NHS will be under intense scrutiny to demonstrate that everything possible is being done to use resources effectively and to bring about measurable improvements in care. Ministers will be keen to show that they understand the public’s concerns and are unwilling to tolerate poor performance. This could bring them into conflict with the leadership of the NHS if politicians seek to replace leaders of hospitals and care systems who find themselves in difficulty “pour encourager les autres.” They also face conflict with trades unions over pay and conditions of staff.

“Critics of the NHS will continue to make the argument that alternative ways of funding and providing care should be considered. Commentators are already suggesting that countries like France and Germany have superior systems that offer advantages over the NHS model.”

“In making this case, they overlook the impact of many years of underfunding in the United Kingdom and a failure to plan for the workforce that is needed. Improvements in care in the decade up to 2010 show that the NHS can deliver good value if there is the political will to do so and sustained increases in funding to make it happen.

“To make this point is a reminder that the crisis affecting the NHS is as much political as it is humanitarian. The failure of successive governments since 2010 to face up to the challenges in the NHS, and social care, is an indictment of a political system geared to short term thinking and an unwillingness to deal with long term challenges that are relegated to the “too difficult” box.

“As well as the impact on patients, there are growing concerns about staff who have been used as the shock absorbers of an underfunded system with consequences for their health and wellbeing that are evident to anyone involved with health and social care.”

But Chris Ham makes no acknowledgement of his own role over decades in destabilising and fragmenting the NHS as a universal, comprehensive public service, free at the point of clinical need

HIs mention of “improvements in care in the decade up to 2010” is a reference to the New Labour government NHS policy of opening the NHS to private companies, hiving off profitable elective procedures to polyclinics (the failed Darzi scheme), importing US managed/accountable care systems through the Kaiser Beacons pilots – and in so doing convert the NHS into a “third way” public/private partnership far from the model of a comprehensive, universal public service providing health care free at the point of use, based on clinical need not financial considerations.

This is entirely of a piece with his promotion of global spy tech company Palantir, together with organisational reform modelled on the US army’s reorganisation in response to terrorism,  as key to the future NHS, as run by statutory Integrated Care Systems.

Chris Ham’s entirely disingenuous opinion piece shows the kind of “opposition” to the Truss government destruction of the NHS we can expect from the proponents of accountable/integrated care: a continued stealth progression to the original New Labour goal of turning the NHS into “third way” “public private partnership” where global companies extract profits and exercise control.


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