A US-inspired reorganisation is about to hit England's NHS – 'help us stop it'

NHS plans due to take effect next spring could make general healthcare as difficult to access as mental healthcare already is – and lock future governments into long contracts with private firms, warn campaigners.

Jenny Shepherd
8 October 2018

Image: Campaigners march to court. Rights: 999 Call for the NHS

Members of the public, NHS campaign groups and trade unions are acting to stop NHS England from introducing a cost-cutting Accountable Care Organisation contract that will make it harder to get the healthcare we are entitled to. In their hundreds, they are donating to help crowdfund a legal challenge to this contract in the Court of Appeal later this autumn.

This legal challenge - brought by national campaign group 999 Call for the NHS and internationally recognised public law firm Leigh Day - is the only way of stopping the contract.

NHS England has recently rebranded the “Accountable Care Organisation contract as the “Integrated Care Provider” contract, to avoid the USA connotations of the term Accountable Care Organisation - the type of healthcare provider used by Medicare/Medicaid, which provides a limited range of healthcare for Americans who are too poor or ill to get private health insurance.

If this contract goes ahead, Clinical Commissioning Groups will be using it to procure a whole range of NHS services from April 2019.

The Integrated Care Provider contract is not fully finalised, NHS England admitted in a recent consultation, making a mockery of the consultation itself. The contract does not even mention arrangements for integrating public health and social care with NHS services, though this is supposedly the public rationale for the change.

999 Call for the NHS say that even if they agreed with the initial premise of contracting - which they don’t - they can’t see that this contract is fit for the provision of social care and public health services.

Why is NHS England in such a rush that it is prepared to expose Clinical Commissioning Groups to the risks associated with procuring huge, complex 10 year contracts for a whole range of NHS, social care and public health services from a new untried form of healthcare provider, on the basis of an unfinished contract?

Perhaps most worryingly of all, this contract would subject a whole range of NHS services to the same kind of cuts and pressures as acute mental health services. It’s designed to “manage demand” for a whole range of NHS services in a given area - in the same way as mental health services contracts already operate. 

Currently, in most NHS contracts apart from mental health, a set payment is made for each treatment provided to individual patients. But the new ICP contract would pay the provider a fixed lump sum at the start of each year, to cover the costs of a range of treatments for the whole population.

The result of this payment arrangement for mental health services is that it is now normal for there to be NO hospital beds for acute mental health patients in their own area. They are routinely taken by ambulance across the country to wherever there’s a hospital bed. And at times, it seems that have been NO acute mental health beds free anywhere in the country, according to Mental Health Network members.

This 10 year contract would lock in that payment arrangement for a whole range of NHS services. 

It would set in concrete new “care models” that are based on the USA’s Medicare/Medicaid system that only provides limited health care for people who can’t afford private health insurance.

A new government would be powerless to stop and reverse this because the contracts would lock it in for a continuous period of 10 years..

Local NHS campaigns together with national 999 Call for the NHS are joining the dots between the cuts that they're fighting in their areas and the contract that 999 Call for the NHS are challenging in the Court of Appeal. 

This Court of Appeal hearing is NHS campaigners' best shot at stopping the contract that could set all these cuts - and worse - in stone for 10 years, imposing the same "demand management" payment arrangement that has been used to decimate acute mental health services.

Jo Land, one of the Darlo Mums who organised the 999 Call for the NHS Jarrow to London March for the NHS in 2014, said: 

“The Accountable Care Organisation contract might seem like a dry legal issue that’s hard to get bothered about. The reality is anything but. This is about whether patients can continue to access the treatments they need, or whether the doctor-patient relationship will be undermined by making doctors put financial considerations ahead of patients’ clinical needs.”

The campaign group point out that the payment arrangement in the Accountable Care Organisation/Integrated Care Provider contract would allow for price competition between providers when bidding for the contract. They argue this is contrary to Parliament’s express intentions, in passing NHS and social care legislation in 2012.

In dismissing the 999 Call for the NHS Judicial Review earlier this year, the court ruled that this argument was a political issue - not a matter for the court.

But the Court of Appeal has allowed an appeal on all seven grounds the campaign group’s legal team applied for - and has speeded up the process because the NHS is important to the public.

Steve Carne, a 999 Call for the NHS campaigner said: 

“Call it what you like - Accountable Care Organisation or Integrated Care Provider - we can’t see that this new way of paying NHS providers is lawful. And if it’s introduced, it will restrict access to NHS treatments and accelerate the creation of a two tier health system. People with money will pay to go private while the rest of us make do with a limited NHS that operates like a health insurance company - putting financial considerations first.”

If you would like to help 999 Call for the NHS to bring their challenge to the Integrated Care Provider contract in the Court of Appeal this autumn, here’s where you can donate.

Can there be a green populist project on the Left?

Many on the Left want to return to a politics based on class, not populism. They point to Left populist parties not reaching their goals. But Chantal Mouffe argues that as the COVID-19 pandemic has put the need for protection from harm at the top of the agenda, a Left populist strategy is now more relevant than ever.

Is this an opportunity for a realignment around a green democratic transformation?

Join us for a free live discussion on Thursday 22 October, 5pm UK time/12pm EDT.

Hear from:

Paolo Gerbaudo Sociologist and political theorist, director of the Centre for Digital Culture at King’s College London and author of ‘The Mask and the Flag: Populism and Global Protest’ and ‘The Digital Party: Political Organisation and Online Democracy’, and of the forthcoming ‘The Great Recoil: Politics After Populism and Pandemic’.

Chantal Mouffe Emeritus Professor of Political Theory at the University of Westminster in London. Her most recent books are ‘Agonistics. Thinking the World Politically’, ‘Podemos. In the Name of the People’ and ‘For a Left Populism’.

Spyros A. Sofos Researcher and research coordinator at the Center for Middle Eastern Studies, Lund University and author of ‘Nation and Identity in Contemporary Europe’, ‘Tormented by History’ and ‘Islam in Europe: Public Spaces and Civic Networks'.

Chair: Walid el Houri Researcher, journalist and filmmaker based between Berlin and Beirut. He is partnerships editor at openDemocracy and lead editor of its North Africa, West Asia project.

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