Accountable Care Organisation

  • By Neil Roberts  From - 27th April 2017

    "The government is 'relaxed' about the crisis in general practice because it thinks Labour can't win the general election, a former GP and health commentator has said.

    Former GP Dr Phil Hammond, who covers health policy for Private Eye, said that ministers were ‘very relaxed’ about the NHS because they believe there is no effective opposition.

    Plans to create large-scale Accountable Care Organisations to run health and social care services across the NHS would eventually lead to all GPs becoming salaried employees, he added.

    Citing a source ‘close to Jeremy Hunt’ Dr Hammond told the annual conference of Londonwide LMCs (Local Medical Committee) on Thursday: ‘They don't believe that Labour is electable. They are very relaxed about the state of the NHS, very relaxed about the queues in casualty, waiting lists going up again, and the disaster in general practice, because they don't believe Labour offers a credible opposition.’

    Dr Hammond said the Conservative government viewed the NHS as ‘a service for poorer people’ and wanted those who can afford it to take out private medical insurance.

    NHS privatisation

    ‘They want private companies to do as much NHS work as possible. And they want the NHS to be allowed to do as much private work as it wants to do. That is their ideology and agenda and they don't believe there is an opposition fighting that.’

    Dr Hammond, who was one of the first journalists to expose the Bristol babies heart scandal in the 1990s, warned GPs that under NHS England drive towards accountable care systems they could all end up in a salaried service.

    The NHS, he said, was ‘keen to move to a model of accountable care organisations where we unify primary, secondary care, social care.’ 

    He added: ‘Ultimately this will make all GPs salaried and working for a large accountable care organisation in a particular area.’

    The Conservative Party did not respond to a request for comment".


    SOH  Comment:

    The vast majority of the electorate know nothing about this. It has not been alerted to the detail of Health and Social Care Act 2012 and Simon Stevens' plans from 2014 for co-called "Sustainability and Transformation Plans". The STPs include American-style "Accountable Care Organisations" - the stress is on the word "accountable" or "cost-controlling". They are part of an entirely new and untried, root-and-branch reorganisation of the NHS which the present Government is bringing in very, very quietly.

    The NHS will be unrecognisable. The National Health Service will disappear and be replaced by many Regional ("footprint"-based) organisations linking local federations of GPs, local acute services and local government authorities. Each "footprint" organisation (ACO) will have a capped budget - no more deficits, no more overspending. Gone over your budget? No more medical service.  The management of the local ACO will devote its energies to finding ways to "deny service". Uninsured and poor Americans know all about this.....

  • Calderdale and Kirklees 999 Call for the NHS article of 1st March 2017


    Simon Stevens, the NHS England Chief Executive,  just told the Public Accounts Committee that some Sustainability and Transformation Plans will soon get going as Accountable Care Organisations or systems.

    This sounds like more tedious, senseless jargonising.

    Indeed one MP, Anne Marie Morris, was so bemused by what Simon Stevens was saying, she asked if they were all smoking dope.

    But behind the jargon smokescreen – whether wacky baccy or not - setting up Sustainability and Transformation Plans to run the NHS as Accountable Care Organisations opens up the NHS to privatisation on a bigger scale than anything seen so far.

    And it is a mechanism for limiting the range of care that the NHS offers, and for denying care to patients who are judged to offer poor value for money.

    This would mean the end of the NHS as a service that provides the full range of health care to anyone who has a clinical need for it.

    How does this work?

    Sustainability and Transformation Plans require the speedy dismantling of the NHS to turn it into a health service that is based on American private health insurance systems – such as United Health,  the former employer of Simon Stevens, now NHS England’s Chief Executive.

  • From: - Julian Patterson


    The Five Year Forward View is a beautiful, intricate model of the future loosely based on a real view. It was popular as soon as it appeared. Every politician and senior manager had a copy. Everybody liked it because it made the future sound lovely, particularly if you closed your eyes while reading it.

    Quick to spot its mass market potential, the publishers rushed out a sequel called the GP Forward View, which allowed family doctors to imagine they had a future too.

    Now you can build your own forward view in just 260 fun-to-collect parts. Build Your Own Forward View is from the same people who brought you Become a World Class Commissioner in 5000 Easy Steps and NHS Reform for Dummies.

  • Talk given at the Learie Constantine centre, Dudden Hill Lane, on 1st December 2016 at the invitation of Brent Patient Voice to an audience of 50 people.

    Dr Julia Simon was until Sept 2016 the head of NHS England's commissioning policy unit and its programme director of co-commissioning of primary care.

    She had worked at London and national NHS level since 2012 on CCG and commissioning issues.


    Dr Simon referred to a small number of presentation slides.

    "There has been a split between commissioning and provision for over 25 years. The 2012 Health and Social Care Act aims to create a truly clinically led system with GPs in the driving seat. But the outcome is actually a fragmented commissioning system with three main budget holders across CCGs, NHSE and local authorities (public health), and a bewildering number of other national organisations.

    In my view healthcare isn't a market: hospitals do not fail. They are always bailed out in order to give citizens care - which seems obvious. Andrew Lansley, the Secretary of State for Health responsible for the introduction of the HSCS Act, is married to a GP.


    There were 212 in 2012 and there are 209 now. They are legally constituted by their members and all practising GPs must be members of one. CCGs have a statutory duty to (1) improve primary care and (2) to engage citizens.


  • STPs must “encourage” long term NHS “partnerships” with the private sector



    Since the Autumn 2015 Comprehensive Spending Review that created the Sustainability and Transformation Fund, both the government and NHS England have explicitly linked the Sustainability and Transformation Plans to the requirement to “encourage” increased private sector involvement in the NHS.

    Some key aspects of STPs’ mandatory “encouragement” of long term NHS “partnerships” with the private sector include

    • Strategic partnerships with the NHS and the 39 Local Economic Partnerships.
    • The abandonment of  “old-style contracting” and the  imposition of private company-friendly contracting.
    • Embedding digital technology in STPs.


    Strategic partnerships with the NHS and the 39 Local Economic Partnerships

    This aspect of Sustainability and Transformation Plans seems to be enthusiastically driven by the NHS Confederation – the trade association for private health companies with NHS contracts.

    It involves increased privatisation and public/private partnerships between a vast range of NHS commissioners and providers, private health companies, voluntary and community sector organisations and a range of other companies, as health and social care services are harnessed to Local Economic Partnerships as a vehicle of economic growth and a way of securing “external investment” in the NHS through “a host of new finance mechanisms”.

    According to the NHS Confederation, which describes itself as a network of NHS “partners” – i.e. private companies – the aim is to “match fund” NHS England’s 5 Year Forward View – the plan behind the STPs.

    This is staggering. They are talking about £hundreds of billions of private sector money coming into the NHS so it will no longer be a publicly funded, owned and managed health service.

    This is ALL being done by stealth.

    This move is supported – again by stealth – by a recent outrageous letter from NHS Providers – the trade association of NHS Trusts & Foundation Trusts – to The House of Commons Select Committee. The letter called for an inquiry that will change the NHS policy framework to bring it in line with STP – driven withdrawal and/or restrictions of a variety of treatments.

    The NHS Providers say this is being done in contravention of the current NHS policy framework of a comprehensive service that is free at the point of clinical need for all patients that have a clinical need for it.

    NHS Providers are asking for an inquiry that will recommend policy changes that will effectively end the NHS and turn it into a brand for a public/private partnership operating along the lines of the US health digitech and insurance companies – Cerner and United Health, respectively – that previously employed NHS England head honchos Mathew Swindells and Simon Stevens.

    The abandonment of  “old-style contracting” and the  imposition of Cerner and United Health-friendly contracting

    Matthew Swindells recently told Clinical Commissioning Groups to abandon “old style” contracting  . What will replace the “old style” contracting – the current system of commissioning and providing NHS and social care services – is  Accountable Care Organisations (ACOs).

    ACOs are a form of public-private partnership.  Think Private Finance Initiative, but for NHS services as well as buildings. The hot favourite ACO model  – plugged by the pro-privatisation think tank the Kings Fund  in  a health system redisorganisation “masterclass” on 12 October – is South Central Alaska.

    Cerner is behind the Kings Fund’s promotion of South Central Alaska ACO as the new STP form of contracting. The company commissioned the Kings Fund report that plugs the South Central Alaska ACO, with the brief to:

    “write a report analysing how an intentional whole health system redesign can deliver better health outcomes to a population. The report, based on independent research conducted by The King’s Fund, focuses on Southcentral Foundation”

    Delivering better health outcomes to a population sounds like a good goal.

    There are just two problems.

    There seems to be no reliable evidence that this model of ‘integrating care’ will reduce costs or improve patients’ health.

    And there seems to be little faith  that it can actually be delivered on the ground. Dr Robert Morley, the Chief Executive of  Birmingham GPs’ Local Medical Committee saysthis model of care is ‘simply undeliverable’:

    ‘The STP, and in particular the plans to massively increase the delivery of out-of-hospital care, to transform general practice and to give it far greater responsibilities across a range of areas are simply undeliverable bearing in mind the meagre additional investment, the unambitious plans to increase primary care workforce and the woefully inadequate intention to support general practice sustainability and viability.’

     So what is driving these ideas? And what are they really designed to achieve?

    Clues leak out in the STPs – and earlier documents like Calderdale and Greater Huddersfield’s “Right Care Right Place Right Time” NHS and social care reconfiguration documents and the 2014  Better Care Fund Submission from Calderdale Council and Calderdale Clinical Commissioning Group.

    These proposals will ‘create a responsive local market’ for health and social care.  They will also ‘reduce the pay bill’ and make increased use of patients’ self management as well as “business-ready” voluntary sector organisations in the new “locality-based” integrated teams.  These are themselves likely to be privatised – with tax avoiding Virgin Care are a contentious front runner that has just mopped up a £700m contract to run Health and Adults Social Care in Bath and NE Somerset.

    Embedding digital technology in Sustainability and Transformation Plans

    The STPs’ “new models of care” are all dependent on a hugely increased use of health digital technology.  Health information systems apparently will deliver a $53 billion market globally in 2019 because of vaguely defined proposals for ‘integrated care’ and ‘care closer to home’. Good news for marketeers, bad news for patients and NHS staff .

    This is the route to turning patients into consumers,  who dispose of a mix of NHS personal health budgets and – if they can afford it – top ups paid for out of their own purse. So, it is the route to a two tier NHS – like the already totally marketised two tier social care system. And the money the patients/consumers spend goes directly to digitech companies like Cerner.

    This is at the say-so of Matthew Swindells, previously Vice President of US health digitech company Cerner, now NHSE National Director for Commissioning Operations and Information

    At the September 2016 NHS Expo– a business-sponsored event plugging the wonders of privatisation via personal health budgets and a bonanza for big pharma and big digitech –  Matthew Swindells announced that digital technology must be embedded in Sustainability and Transformation Plans.

    New STP Digital excellence centres – also announced at NHS Expo – promote patients’ use of smartphones and mobile devices. The Acute Trusts that are centres of digital excellence will set up digital technology so that patients can access more services via smartphones and mobile devices.

    This ties in with the so-called Care Closer to Home scheme that copies the model for “demand management” used by the American private health care company, Kaiser Permanente.

    It requires patients with long term health problems to monitor their own symptoms at home using interactive digital technology that will send data about their bodily processes to specialist nurses and/or GPs.

    The aim is to target care without relying on expensive personal contact between doctors/nurses and patients as a way of checking on patients’ health.

    The system would also direct behaviour change incentives and messages to people statistically at risk of developing various illnesses. This aims to reduce the likelihood that they will become ill.

    But there’s little evidence that this actually works.

    And it looks as if a lot of the much-vaunted increase in NHS funding via the Sustainability and Transformation Fund, is going straight into the pockets of digitech companies like Matthew Swindell’s former employer.

    Here is what Cerner has to say   about the kind of health digitech that the £100M Digital Excellence Fund is going to pay for:

    “Cerner has several exciting projects and relationships related to some key aggregation platforms, including Apple and Validic, which are on the augmented self-management end of the remote monitoring spectrum, and Qualcomm Life, which is active monitoring. Cerner also has a relationship with Livongo to improve outcomes for diabetics. These relationships will increase the ability for Cerner clients to track their patients remotely, whether to manage chronic conditions through a prescribed device or kit, or through an ecosystem of apps enabling patients to manage their day-to-day health.”

    The NHS England panel that chose which Trusts to award the centres of digital excellence funds to was apparently led by Professor Keith McNeil, NHS England’s first chief clinical information officer, who reports to Matthew Swindells.

    And Simon Stevens had previously announced at the 2016 NHS Confederation conference  that:

    “…from April next year, we will add a piece to the national tariff system specifically for new med tech innovations that have been shown to be cost-saving or help patients with supported self-management.”

    This sounds a lot like a repeat of Tony Blair’s NHS Programme for IT (NHSPfiT), which pretty much ended in tears. Is the STP Digital Excellence scheme going to do any better? And will it even matter to the revolving door merchants Simon Stevens and Matthew Swindells, who are pushing it? After all, as Stuart Player and Colin Leys wrotein 2010 :

    “…the plan to turn the National Health Service into a healthcare market does not rest on rational arguments but material interests… the plans are not really new, but are the culmination of a decade-long campaign by the private health industry to get its hands on the NHS budget.”

    And that is what the STPs are really about:  cuts, privatisation, and a paradoxical central control over “devolved”, fragmented public/private NHS and social care.



    Please sign the 38Degrees petition HERE

    To: Jeremy Hunt, Secretary of State for Health and Simon Stevens, CEO NHS England

    STOP the destruction of our NHS. Call a halt to the Sustainability and Transformation Plans NOW

    Why is this important?

    This is the biggest attack on the NHS you've never heard of.