The decision to accelerate the development of Accountable Care Organisations (ACOs) in England is unwise, unnecessary and should be challenged. It is hoped the SHA will support the Judicial Review and the Early Day Motion from Labour.
Sadly ploughing ahead with the contracting model for ACOs without any proper explanation, consultation or engagement is typical of what the NHS has been doing, with the secrecy around Sustainability and Transformation Plans as a textbook example of how not to do things. You cannot make changes on this scale without taking staff patients and public with you – and you should not try.
It’s time to stop, consult and think again. In earlier communications NHS England were saying that it would be some years before the first ACOs could emerge – what is the hurry?
Moving to ACOs is a major change. An ACO has its own legal form with a legally binding contract “for the majority of health {primary, communication and secondary including GPs} and care {social care} services and population health {mostly now with local authorities} for a defined area”. As NHS England has made clear the contract for an ACO will have to go through a proper procurement process.
An ACO need not be a public body but it will get income from public funds in £hundreds of millions and will plan and provide vital services for populations of hundreds of thousands.
ACOs are described in the limited documents so far as the next step along the path that started with the Sustainability and Transformation Plans, which are becoming Accountable Care Systems and only then ACOs. In a few places like Northumberland some good progress has already been made but most Sustainability and Transformation Plans are still in cloud cookoo land.
The implications of moving to an ACO will be felt across both NHS commissioners and providers but also local authorities and many third sector and a few private sector organisations. It has major implications and yet so far there has been little or no attempt to explain and consult about this with staff, patients and the public – it’s mostly the NHS talking to itself. It will be yet another bail out of hospitals plan. Few local authorities accept they have been adequately engaged anywhere along this path yet they should be leading the process if it is about population health and wellbeing.
Concerns are obvious. It is entirely possible, some would say inevitable, that an ACO will be led by or include a private sector organisation; as we have seen in earlier skirmishes around service integration in Cambridgeshire and Staffordshire, which failed spectacularly after early enthusiasm.
So how will these new bodies be held to account? They are getting lots of public money so who decides how much and what outcomes are set for the contract? How do local authorities and NHS control the money and the performance? Are some staff still in NHS and others not?
The issues are many and complex and solutions have consequences.
In a public system, as in Wales and Scotland, the merits of ACOs might outweigh the disadvantages and we can already observe what is happening in our neighbouring countries as they progress in a more measured way to better integrate services; something known worldwide to be far from easy. And even in market ridden England it is possible to use ACOs as part of a move to proper population based planning of services, to removing the commissioner provider split and to joining up better disparate services for the benefit of service users.
But a change on this scale will only have a reasonable chance of success if it builds on public understanding and support. Nothing has been learned from the ludicrous antics of some Sustainability and Transformation Plans.
And to be clear the huge strain on the NHS and social care is due to inadequate funding with serious workforce issues as a consequence. Forming a few ACOs will make little or no difference and could just be a distraction from making care as good as possible under almost impossible circumstances.
Stop now. Explain. Consult. Think again. What is the hurry?