Some of our biggest concerns about ACOs received very welcome endorsement from Parliament’s Health Select Committee in their report Integrated care: organisations, partnerships and systems published this week.
The report acknowledges the risks of trying to ‘work around’ the current laws, which were “intended for a different purpose: to facilitate choice and competition within the NHS,” and concludes “The law will need to change.” (Recommendation 38) That has been one of the key arguments in our Judicial Review.
While the report is sceptical of our argument that integrated care is opening the way to increasing involvement of private corporations in the NHS, we are delighted that Recommendation 17 supports another of our assertions: “We recommend that ACOs, if a decision is made to implement them more widely, should be established in primary legislation, as NHS bodies” and goes on to suggest how that might be achieved.
Recommendation 23 states “There has not been a clear and compelling explanation of the direction of travel and the benefits of integration to patients and the public.” This echoes the other Ground for our legal challenge, which is that the Secretary of State for Health and NHS England have breached their common law duties to publicly make clear their proposals to reorganise the NHS in England using ACOs.
The Report is strongly critical of the whole way in which Sustainability and Transformation Plans, and the different organisational structures that they have spawned (STPs, ACSs, ACOs, ICSs and ICOs), have been introduced in a top-down way, with excessive secrecy, with documents full of unintelligible jargon, and with very little input from the public, the broader health professionals and local government, and to an unrealistic and damaging timescale.
The recognition that organisational changes of this nature “are no substitute for effective solutions to funding and workforce pressures” is crucial to addressing the critical condition of the NHS.
We feel that this report vindicates the stance taken by JR4NHS, including the late and much-missed Prof Stephen Hawking, and by a host of other campaigners.
Our two day hearing took place on 23 and 24 May and we await the court’s judgement. Whatever the judge’s verdict, we have achieved a lot. The Government has been forced to concede proper public consultation on ACOs, and Parliament seems finally aware of their dangers and shortcomings. Thank you all for your continued support.