Accountable Care Organisations (ACOs) and Accountable Care Systems (ACSs) are being established by NHS England as a new phase in the development of Sustainability and Transformation Plans (STPs). NHS England aim to bring together local NHS organisations, in partnership with social care services, to join up the health and social care system.
In September, the Department of Health launched a consultation seeking views on changes to regulations required to develop ACO contracts. The government proposes to make these changes to the NHS without a vote in parliament, and they will have legal effect from February 2018. These regulations will have far-reaching implications for commissioning in the NHS. Large scale organisational changes of this kind should be subject to proper scrutiny.
There are unanswered questions about how ACOs will be accountable to the public, what the levels of private sector involvement will be, and what the implications will be for NHS staff. STPs have been controversial and concerns have been raised that they are a way for the government to cut NHS services. The government has not said how it will deliver the funding which would be needed to make ACOs work. Indeed, following the Budget, NHS England said that the government’s financial settlement will mean the NHS will ‘not be able to do everything being expected of it’ and that difficult decisions will need to be made about which services and treatments it can deliver.
The current, entirely predictable and avoidable, winter crisis is the most dramatic illustration of the underlying chronic problems of the NHS, which will not be solved by further costly and unnecessary organisational change.
The sustained underfunding of the NHS is stretching the finances of our healthcare services beyond their limits. There are real concerns that ACOs could be used as a vehicle for greater rationing of treatment locally. It is essential that the decision on whether to introduce ACOs into the NHS is taken in public, with a full debate and vote in parliament. That’s why the Opposition front bench has tabled EDM 660, as part of a campaign to force the government to hold a debate on these changes.
I have signed EDM 660 to call on the government to provide parliamentary time for MPs to debate and vote on whether to introduce ACOs into the NHS. The secrecy in which ACOs have been conceived and are being pushed forward is contrary to the government’s duty to be open, transparent and accountable in NHS decision-making.
As a member of the Health Select Committee, I welcome the letter sent by our chair Sarah Wollaston MP which asked the Secretary of State for Health to pause the introduction of ACOs until we have concluded our select committee inquiry into the matter.