Well. Apologies. I thought I was up-to-date with all the structures and new developments in the NHS. And I’m absolutely not. Thing is, I realise now why Jeremy Hunt did his utmost to persuade Theresa May that he should not being moved on as Secretary of State for Health, and must remain as Secretary of Health and Social Care.
And what did I say about we didn’t want a new Secretary of State who would begin yet another re-organisation? Better the devil you know? Geez and – sigh! That man Hunt is on a mission, and there is yet another very profound NHS re-organisation going on right now. This is about ACOs or Accountable Care Organisations. Have you heard of them? Yes? Good, you’re way ahead of me. No? Well they’re happening. OK. Now, in Facebook a meme is going round on these structures, which actually I think I’ll just step back from a bit, as I don’t know where the instigator/s of said Facebook post have got their facts.
What is happening is this:
- Accountable care is the latest buzz phrase (of which I was not aware)
- It is a way for different organisations from both health and social care to work together (good)
- It is a shift away from competition and a move towards a collaboration of and between very different and separate organisations like GPs, hospitals and the local authority (same thing but all good then)
- The language of accountable care comes from the States (oh)
- Does that mean that this is the way to bring in more privatisation and/or an insurance based health service (a key question)
- Apparently, no, as these English versions of accountable care will be tax funded (OK)
- There are currently 10 areas across England currently setting up Accountable Care Systems leading to ACOs (oh, OK, right)
The thing is when boundaries between health and social care are dissolved and these new structures are created (called Accountable Care Organisations) we should ask what powers will these ACOs have? And who will they be accountable to? Some views are that these ACOs would permit commercial non-NHS bodies to run health and social services. And when they do, note their provision to us will be governed by commercial contracts not government statutes.
So, is this bureaucracy gone mad, yes? No, sadly this is the way of the world. You think improving the NHS would be to get rid of bureaucrats? Sorry, we have moved into a complex world of procurement around the provision of health services. Anyway, stepping aside from hyperbole, after a quick scout round there is the King’s Fund (a very high-profile think tank that has a good and balanced reputation) who says it doesn’t mean a larger role for private providers, and others like senior health professionals and campaigners who are arguing for a judicial review on these proposals, because they think it does.
Whatever. Just note that this is an extension of the contract culture that I wrote about in my last post. Remember Carillon? (Do have a look at this link as it takes you to the healthcare part of their website.) We will face the danger of commercial entities bidding for contracts that could fail because they undercut to get that contract. What a way to run a public service!
What do I want people to do? The reason I write here is about grasping and grappling with what is going on out there. We have to know, we have a duty to know. We have to wake up, and we must understand the consequences of government actions. I’m telling you before it is too late for the NHS that we must get rid of this government. (And I know the General Election is some way off, but just be aware) Because it is nearly, as in almost, too late to save the NHS. Why? Because the cost of bringing services back in-house will be exorbitant because compensation will be governed by commercial laws. So, if we don’t push and resist, and people like Hunt remain unchecked, there will not be an NHS as we know it. Yes, it might be free for a while, but behind closed doors there is a continuous move towards private companies (that can only have profit in mind, because that is what they do) providing health care. And I cannot emphasise enough that this means their obligations to patients are and will be constrained and limited to commercial considerations. There will still be great doctors and wonderful nurses but if commercial companies under-cut too much and get into debt and walk away (it’s happened) who will pick up the bill, and the care?
And can I ask? What will actually change? It is so easy for people at the top to agree to work together. I’ve seen so many variations of committees run for and by top managers of health and social services who say we need to work more closely together. Middle managers are then tasked to start the process – but on the ground, where patients actually live – do you see what I mean? What happens? Yes, how will Accountable Care Organisations work when the frail and ill, and older people begin to get their multiple morbidities? Management of change is easy at the top, but, in reality who will look after people in the community – poorly paid carers? And where is the private sector in all this? I am asking what do all those words mean, and where will that humungous effort to change our health care systems to ACOs end up? The key question is what will be the outcome of this change? Better care? One would hope so. Or is it all about cheaper more commercialised care?
So, watch this space and be aware of, and beware silkily-spoken words about new arrangements for health and social care.
Penny Kocher 20th January 2018
Also see a seven step guide to accountable care – click here