Suspicions over accountable care organisations in the NHS | Letters

Readers respond to a Guardian article by Bruce Keogh, medical director of the NHS in England

I am one of those who are deeply suspicious of the accountable care organisations (ACOs) that Bruce Keogh describes in Panglossian terms but does not name (As the NHS turns 70 we need it more than ever, 1 January). Since the release of Simon Stevens’ Five Year Forward View in 2014, we have been told how the patient is at the centre, with care closer to home, “no decision about me without me”, but have watched as services get more difficult to access despite the wondrous efforts of the workforce, both NHS and in the care sector. Lack of funding and being forced to “make savings” have been the mechanism that has caused the crisis, but the fragmentation and outsourcing that followed the Health and Social Care Act of 2012 have been expensive and damaging too.

Those costs and inefficiencies will not go away with the introduction of ACOs but the role of multinational health businesses will be much enhanced by their involvement as “partners” at the heart of the fixed budget “complete care systems”. They will be influential in decisions about who qualifies for healthcare and who will be told their needs are social care and therefore means tested. They will shape the pattern of subcontracting and the percentage of NHS funding going to private providers. We also need to know much more about how the technology-based improvements are to be paid for. Most of the suppliers are the same companies getting their feet under the table of the ACOs. Almost certainly, private finance will be used, despite what we know of the horrendous long-term costs of PFI.

Continue reading... January 03, 2018 at 12:07AM