Accountable Care ding ding round 2

A few weeks ago, Calderdale TUC passed the Motion ‘Oppose Accountable Care Systems’.

Since then, the government and NHS England have been ducking and diving. Apparently sidestepping the contentious Accountable Care Organisation contract, at least until after the public consultation on the contract, they are pushing “informal” Accountable/Integrated care arrangements instead.

They’ve also decreed the word “Accountable” should be dropped and replaced with “Integrated“.

Unimpressed, campaigners are battling on to protect #NHS4All.

We are going to get to the bottom of what is going on. And here is how.

Accountable Care Organisation Contract seems to be on hold

Pending the two Judicial Reviews of NHS England’s Accountable Care Organisations/Models contract and NHS England’s ACO contract consultation, NHS England has apparently decided NOT to promote/authorise Accountable Care Organisations and NOT to authorise any use of the Accountable Care Organisation/Models contract with the capitated Whole Population Annual Payment mechanism.

(A capitated Whole Population Annual Payment means Commissioners would pay the Provider on the basis of a fixed amount per head for the whole population – rather than paying for the actual treatments that patients receive. Combined with harsh financial controls, this shifts financial risk to providers – and therefore to patients, as it would increase current pressures to restrict patients’ access to elective (planned) care. This would accelerate the development of a two tier health system, where those who can afford to pay go private and the rest are left with limited NHS care. Its use by Accountable Care Organisations in other countries has led to cherry picking patients whose treatment offers the best value for money, rather than providing healthcare on the basis of patients’ clinical need. The 999 Call for the NHS Judicial Review challenges the lawfulness of this payment mechanism.)

Northumberland, Devon, Cornwall, Sunderland, Scarborough and Ryedale and N. Tyneside, for starters, have announced that they’re not looking to go down the Accountable Care Organisation route at least for now. Greater Manchester and Dudley, the two areas that were to have piloted the Accountable Care Organisation contract, have said they are delaying this.

This has not stopped the first wave Accountable Care Systems  from bashing on.

Opposition to “Informal” Accountable Care Systems/Integrated Care Systems

It looks as if these will operate by setting up some kind of Integration Agreement or Alliance Agreement about how the various statutory NHS organisations and local authorities will work together, while finding ways to align or possibly pool their budgets. But opposition is growing.

Impelled by a strong Devon Save Our Hospital Services campaign, Devon Health Scrutiny Committee has told the Council Cabinet to defer any decision on implementing the new shadow Integrated Care System until the Scrutiny Committee have been given full disclosure of the governance, management and checks and balances that would be a part of the proposals.

How wrong can Simon Stevens get?

This was shortly after after Simon Stevens, NHS England Chief Exec, told the House of Commons Health & Social Care Select Committee that the Devon Integrated Care System was now “motoring”.

Apparently unaware that Devon Council Scrutiny Committee had called in the very paper he was praising, Simon Stevens said (Q 314)

“For those of you interested in Devon, there is an excellent paper from the chief executive of Devon County Council explaining what it is all about, reviewed by their cabinet last week. It makes the case very clearly that staff are working across organisations and that, if people need to be admitted to hospital, they will be supported to get care at home more quickly, and the NHS and local authorities are now working more closely together than ever. That is what Devon County Council is saying. That is an example of where I think people are now motoring.”

It is unclear whether fixed ‘per head’ budgets have been put on hold

This is a key murky area that needs a strong light shining on it.

NHS England’s headlines about NOT authorising any use of the Accountable Care Organisation/Models contract with the capitated Whole Population Annual Payment mechanism, until after the public consultation on the contract, say one thing.  The small print of what Clinical Commissioning Groups are actually DOING seems to say another.

Here’s an example. Last November Scarborough and Ryedale Clinical Commissioning Group awarded an out-of-hospital “integrated care” MultiSpecialty Community Provider contract, due to go live on 3rd April. This is a variant of the Accountable Care Organisation contract and  is based on capitated payments. Since January, the Clinical Commissioning Group has been “mobilising” the contract to go live. But a Freedom of Information response on 23 March from the Clinical Commissioning Group stated that they have reverted to the standard NHS contract, pending the outcome of NHS England’s ACO contract consultation. However, it’s unclear what this reversion to the standard NHS contract means. Scarborough and Ryedale Clinical Commissioning Group’s  Freedom of Information response also says,

“The CCG has…ensured that all materially relevant sections of the ACO contract have been incorporated within the standard version.”

What on earth?

Here’s another example. Coventry and Warwickshire Clinical Commissioning Groups have appointed South Warwickshire NHS Foundation Trust as lead provider for community services in south Warwickshire, Rugby and north Warwickshire, and Coventry and Warwickshire Partnership NHS Trust as lead provider for community services in Coventry. The community services contract is based on a capitated payment.

So who knows what’s really going on?

Glen Burley, South Warwickshire Foundation Trust and Wye Valley Trust chief executive, told the Health Services Journal in article published on 15 March that this means the Trust “have technically become, albeit in a small way, an integrated care organisation.” They are now responsible for commissioning/subcontracting elements of the area’s community services and are looking to create a gain share agreement with GPs, so that if GPs don’t reduce the number of patients they refer to hospital, they don’t get all or some of the incentive included in the capitated contract.

NHS England has rebranded Accountable Care as Integrated Care

In an attempt to detoxify Accountable Care by removing the pesky connotations of the USA’s Medicare/Medicaid system, the government and its quango NHS England have re-branded Accountable Care as Integrated Care.

The spin changes nothing, they are still the same cuts- and privatisation- driven dismantling of the NHS. Just with a better-sounding name.

As the Calderdale TUC motion explains, Integrated/Accountable Care Organisations or Systems’ “new care models” are based on cutting hospital services and replacing them with out-of-hospital services, with considerable reliance on the voluntary sector, patients themselves and families and friends to provide care. AKA Care Closer to Home. Private health companies like Totally Ltd have told their shareholders this creates a “massive market opportunity” for them.

Put your elected representatives on the spot – be like Devon Save Our Hospital Services!

An example of the start of a successful fightback is the Devon Health Overview and Scrutiny Committee’s clear statement that Councillors have no idea what is going on with the Devon shadow Integrated Care System- and now they are going to use their powers to remedy that lack of information and determine what is carried out.

We all have to put our elected representatives – Councillors and MPs – on the spot. Do they have any kind of clue about what they’re going along with (if they are)? Make it clear we don’t agree with this course of action (and why). We also need to constantly challenge our local NHS organisations about what they’re doing – in particular the Sustainability and Transformation Partnership leaders and Board and local Health and Wellbeing Boards.

Two new Judicial Reviews of acute hospital cuts

Two new Judicial Reviews are challenging the lawfulness of proposed acute hospital cuts and closures, that are key parts of Sustainability and Transformation Plans.

Simon Stevens may have told the House of Commons Health & Social Care Select Committee on 20th March that:

“Dorset…had a clear plan, and I think they are able to push on with that. We have backed it with capital and they are progressing well.”

But back in the real world, the upcoming Defend Dorset NHS’s Judicial Review of Dorset Sustainability and Transformation Plan challenges the lawfulness of proposed hospital bed cuts, Poole A&E downgrade and closure of Poole maternity services.

Hands Off HRI’s upcoming judicial review challenges the plan to knock down Huddersfield Royal Infirmary and replace it with a small planned care clinic to serve both Greater Huddersfield and Calderdale, plus an urgent care centre (that would not treat children under 5) – leaving Huddersfield people without an A&E or any acute hospital services. This is a key part of West Yorkshire and Harrogate STP.

Across England, campaigners are fighting unevidenced cuts, closures and centralisation of hyper acute stroke services.

You can see why we need to challenge at every level

Some questions to start the process can be found on our #NHS4ALL Councillors page.

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