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.