Campaigners prepare judicial review to block roll-out of ACOs

Campaigners hoping to block the rollout of American-style accountable care organisations (ACOs) in the NHS have begun fundraising for a legal challenge that could begin this month.

High court (Photo: iStock)
High court (Photo: iStock)

A group led by academics Professor Allyson Pollock and Professor Sue Richards, and clinicians Dr Colin Hutchinson and Dr Graham Winyard, say that plans to introduce ACOs in England could bring about the 'biggest change to the NHS since it came into existence'.

The campaigners plan to launch a bid for a judicial review before Christmas to block the roll-out of ACOs, warning that the public has not been properly consulted on plans that could hand control of NHS commissioning and provider services to private companies.

The DH consulted on a proposed model contract for ACOs earlier this year, but the campaigners say this falls far short of the public consultation required for a major NHS reform.

NHS reform

Under NHS England plans for the evolution of the country's 44 sustainability and transformation partnership (STP) areas, STPs could develop into 'accountable care systems' - with NHS and potentially social care organisations integrating across a geographical area to pool budgets and run healthcare.

These could develop into ACOs, in which commissioners for an area would have 'a contract with a single organisation for the great majority of health and care services and for population health in the area'. NHS England chief executive Simon Stevens has said that GP practices could be vertically integrated into these organisations.

NHS England says that although some areas have already begun developing plans to form ACOs, 'the complexity of the procurement process needed, and the requirements for systematic evaluation and management of risk, means they will not be the focus of activity in most areas over the next few years'.

King's Fund chief executive Professor Chris Ham said on Twitter this week that 'accountable care organisations and systems are about integration not privatisation'.

But campaigners fear ACOs could appear more widely, warning they will not be statutory NHS bodies, and could be controlled by organisations operating for profit, including venture capitalists, insurance companies or banks, with provision of healthcare services subcontracted out to third parties. Dr Hutchinson told GPonline that it was 'extremely likely' that some ACOs would be operating in the NHS from April 2018.

GP leaders have warned that if practices integrate with the new organisations under rules that allow their contracts to be suspended and their funding pooled, this may prove impossible to reverse.

Public consultation

Lawyers acting for the campaigners seeking a judicial review wrote to the DH and health secretary Jeremy Hunt this week demanding a guarantee that the government would carry out a full public consultation and provide a clear description of its plans before proceeding with the rollout of ACOs. The group says government lawyers warned in response that they would 'robustly defend any judicial review'.

The campaigners hope to raise £144,000 to fund the judicial review, which lawyers believe they have a strong case for.

Dr Hutchinson told GPonline: 'The introduction of ACOs will be the biggest change to the NHS in England since it came into existence. Most people have no idea what they are, and we think if they did they wouldn't want anything to do with them.'

Dr Hutchinson said: 'They will essentially have a monopoly over health and social care in a particular area of the country. They will operate under multibillion-pound contracts to commission and provide or subcontract most of the healthcare in an area for up to 10 or 15 years. They will be responsible for allocating resources, deciding which services are provided and to whom, which services are free and which are means tested or to be paid for out of pocket or through insurance.

'Serious questions have yet to be answered - such as why are ACOs the only way to integrate care? There has been no information provided, so far, on the impact that ACOs could have on the range and scope of NHS services provided.'

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