Accountable Care Organisations

Thank you to those who have contacted me about Accountable Care Organisations and the related Early Day Motion 660.


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.


There is a lot of misunderstanding and misrepresentation about the different models of integration between health and social care that are being developed around the country. The best explanation for what is going on has been published by the highly respected King’s Fund here:

As this makes clear, there are clear opportunities here for vertical and horizontal integration, which would actually move beyond the Single Market and in a public (as opposed to a private system like America’s) make private contracting less, not more likely. Paradoxically, one of the reasons NHS and Social Care leaders are pursuing these models is that they enable them to “work around” the disastrous impact of the 2012 Health and Social Care Act, which forces commissioners to go out for tender.


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 and I agree with you that large scale organisational changes should be subject to proper scrutiny.


As it stands, 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 Government and NHS England only has itself to blame for some of the public reaction to these models of integration, because it has adopted an acronym for an American system (ACO) which is not replicable in a public system like ours, instead of simply focusing on place based integrated care.


The Labour Party is completely committed to defending the NHS and we would repeal the 2012 Act to make the NHS the preferred provider. I am very proud that the last Labour Government achieved record short waiting times, record high public satisfaction and record high staff morale in the NHS.


I believe the sustained underfunding of the NHS is stretching the finances of our healthcare services beyond their limits, I believe 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.


I have signed EDM 660 and I agree that the Government should 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, I believe, unhelpful and contrary to the Government's duty to be open, transparent and accountable in NHS decision-making.


I would be very concerned if a campaign based on misconception about structures, diverted us from the main task of exposing this Tory Government’s chronic underfunding of the NHS and Social Care and from ensuring we get a Labour Government as soon as possible to address that.

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