Pressure to halt the dash towards “accountable care” models was increased by the Chair of the Commons Health Committee Sarah Wollaston urging Jeremy Hunt to put the process – and the new regulations to empower the new ACOs – on pause pending a committee review. She in turn was clearly responding to public pressures and concerns.
This is far from the first time NHS England has found itself effectively hog-tied by a combination of public opposition, professional reservations and the political impasse of a government which, especially since the June 2017 election does not have a stable parliamentary majority to change the law and step away from the disastrous 2012 Health and Social Care Act.
To make matters worse, as a recent National Audit Office Report has again pointed out, few if any of the new models of care and new ways of working favoured by NHS England have any evidence to support them.
Pressure to discharge people more quickly from hospital is also having at best mixed results, with emergency readmissions up by an estimated 22% over 4 years to 2017, double the increase for emergency admissions.
One of the key factors in the various plans to remodel services has been the need to expand community services to care for people outside hospital.
But there is no new money to invest in expanded services, and as the NAO notes, the Department admitted last October that they had no clear plan for how the estimated £10 billion spent on community health care could be better used to manage current and future demand. The proposed Forward View for community services was abandoned in February.
Campaigners, many of them working with Health Campaigns Together, made it impossible for NHS England to carry through their original plan for Sustainability and Transformation Plans in 2016, and made the term itself politically toxic in 2017.
Then after the 2017 election widespread anger at the potential impact of the “Capped Expenditure Process” to restrict spending to NHS England-dictated “control totals” meant that approach too was swiftly ditched.
Attempts to switch the focus to “Accountable Care” last summer and autumn triggered two Judicial Reviews, still pending as we go to press, and increasing public rejection of any “American” model – with even the King’s Fund warning the ACO concept was “deeply unpopular” with the public.
Judicial Reviews are also hampering NHS England efforts to drive through any of its plans for reconfiguration of services in several areas.
Even February’s change of label to “Integrated Care” has not solved any problems.
Private sector companies have made it clear that they do not expect to be winning contracts to run the new systems, as many people had feared. Indeed the only big contracts to have been awarded have gone to existing NHS providers, not multinational corporations – not least because of the pitifully low levels of funding now available for the new contracts.
We are by no means out of the woods yet.
Small-scale community contracts are still being awarded to private bidders despite a succession of private sector contract failures. The NHS is still burdened with the costly and dysfunctional market system and irresponsible CCGs imposed on the NHS by the 2012 Health & Social Care Act.
However it is clear that in this 70th anniversary year we are a long way from the much bigger private sector inroads that many feared were inevitable. The tide of opinion an evidence is with us in fighting back to defend and restore the public sector model of the NHS and drive out the privateers from contracts and scrap PFI.
So we fight on: and we can win!