Accountable Care System

Demand for democratic control in new Integrated Care System for NHS and social care dominates Devon County Council cabinet discussion

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A passionate demand by Labour Councillor, Hilary Ackland (below), for greater democratic control in the new Integrated Care System for health and social care made a major impact as Devon County Council’s Cabinet finally considered the proposals which Hilary Ackland.JPGthe Clinical Commissioning Groups have been developing since September.

Cllr Ackland said that a revamped Health and Wellbeing Board should be an Integrated Commissioning Board with decision-making powers in the new system, and proposed broader, cross-party representation.

I agreed that ‘democratic control is not an optional extra’, and said that governance proposals should be discussed before the Council approved the system. Replying, the opportunity for greater democratic input into the local NHS was emphasised by Chief Executive, Phil Norrey. Conservative Cabinet member, Cllr Andrew Leadbetter, had proposed a paper which agreed that governance issues needed to be addressed but made no specific proposals. The issue will now go to Health Scrutiny, hopefully on 22nd March.

In my speech, I welcomed the CCGs’ retreat from the idea of an Accountable Care Organisation, for which I said the judicial review joined by Stephen Hawking, as well as the hung parliament and local campaigners’ pressure, should take the credit.

  • I also drew attention to uncertainty about how the financial organisation of the new system will impact on chronic failures of patient care.
  • I warned that attempts to equalise funding between areas of the county could lead to even sharper cuts in Eastern Devon.
  • I pointed out that the CCGs, even after 6 months, had failed to produce a single paper describing the Local Care Partnerships which are a key element of the system.
  • The paper called for ‘public engagement’ – but there has been none, and even councillors do not understand the proposals.

I called for a delay in decisions until fuller information on all these points, as well as governance, was available. But the Cabinet unanimously adopted the proposals as they stood – the issues will go to Scrutiny before coming to full Council.

The debate is at 1.44, resumed at 2.22, in the webcast.

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County Council Cabinet member says of NHS changes, ‘What we’re not going for in Devon is an Accountable Care Organisation’ – but can we take this assurance at face value?

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At Devon County Council yesterday, I asked Cllr Andrew Leadbetter, Cabinet Member for Adult Care and Health, whether the Devon Accountable Care System (ACS) (which is being renamed the Integrated Care System!) is still due to start on April 1st. He replied that ‘What we’re not going for in Devon is an Accountable Care Organisation’ – only an Accountable Care System.

He said that the 1st April date was the one ‘on which the two CCGs [NEW Devon and South Devon & Torbay] are going to merge’ and that the ACS already existed in all but name. ‘It’s their plans, they don’t actually need our permission to go ahead with it’, he added – although DCC is ‘in partnership with them’. He didn’t answer Cllr Brian Greenslade’s point that DCC had glossed over it in a recent spotlight review.

You can WATCH THE EXCHANGES BY CLICKING HERE AND FORWARDING TO 2:57. 

However I think there’s a confusion in Cllr Leadbetter’s response and in the joint statement with the CCGs which he issued as a written report at the meeting and previously emailed to councillors:

  • No one has said that the Devon CCGs, through the Sustainability and Transformation Plan (STP), are currently introducing an Accountable Organisation (ACO), the new form of long-term NHS provider contract which has been developed by NHS England, could hand over large chunks of the NHS to private including American companies – and will shortly be judicially reviewed.
  • However according to the CCGs, Phase 1 of the Accountable Care System in 2018-19 will develop an ‘integrated delivery system for Devon’ with a ‘single strategic commissioner’. 
  • And according to the report Designing the commissioning system in an accountable care environment: A route map for Sustainability and Transformation Partnerships which describes how the Devon STP has been working – and which Dr Tim Burke, Chair of NEW Devon CCG says is the ‘route map’ for the accountable care system – this integrated system is designed to lay the basis for Accountable Care Organisations.
  • On page 18, the report says that the integrated delivery system, ‘Through bringing budgets together on a whole population and/or model of care basis, [will] provide signals to providers on how to organise. This will signal the number, shape and scope of accountable care organisations and how they will need to work together to deliver.’

SO – Cllr Leadbetter is right, the emerging ACS is not an ACO. But the ACS is designed to lead to the setting up of ACOs.

Unless, of course, they have changed their mind. Is the route map still the route map – or not? This is the question that the CCGs and Cllr Leadbetter need to answer, before his ‘assurances’ can be considered meaningful. As he mentioned yesterday, I and other councillors will be meeting with him and the CCGs to discuss these issues further.

(Other noteworthy point:

NOTE FOR BAFFLED READERS: I know this is an incredibly complicated subject, not helped by their tendency to change the name of what we’re talking about as soon as objections are raised – as though that makes it better! If you’re confused – you’re not alone. However it MATTERS A LOT to the future of the NHS. Read this report explaining the issues, which I submitted to the Health Scrutiny Committee last month.

 

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Is Virgin Care elbowing NHS organisations out of contracts by under-bidding? As Devon prepares for its Accountable Care System with controversial long-term contracts, this report raises troubling questions.

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FROM Private Eye: Deep in Virgin territory

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Health Scrutiny agrees to my request to scrutinise controversial plan for Accountable Care System in Devon from 1st April – I tell them there is no public consensus for private companies running our NHS

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Yesterday’s meeting of the Devon Health and Adult Care Scrutiny Committee agreed to my request for a special meeting to discuss the introduction of an Accountable Care System in Devon, if this goes ahead as planned on 1st April. However if the system is delayed, it will discuss the system at its scheduled meeting on 22nd March.
I told the Committee that in the light of the controversial nature of Accountable Care Systems, it was wrong that no consultation had been held with the Committee, the County Council or the public.
I pointed out that in Cornwall, an open inquiry into a similar proposal had been held, and that the parliamentary Health Select Committee, at the instigation of Dr Sarah Wollaston MP, had launched an inquiry into Accountable Care Organisations (ACOs), the new kind of contract proposed within Accountable Care Systems. Jeremy Hunt, the Secretary of State, had welcomed this inquiry and while the Committee was meeting, NHS England announced a 12-week public consultation into these organisations.
I said that a major concern was that ACOs would be 10-15 year commercial contracts and could be given to private providers. Although NHS England’s statements points out that the two contracts so far proposed are going to NHS organisations, Mr Hunt’s letter to Dr Wollaston on 22nd January makes it clear that they can equally go to private companies. ‘Especially after Carillion, there is no public consensus that private companies should run large areas of our NHS’, I told the committee.
Moreover, at the hear of ACOs is the idea of ‘capitated care’, which I told the committee ‘could lead to rationing of routine operations and treatments, forcing better-off patients into private care and leaving a second-class service for those who rely on the NHS’.

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After Sarah Wollaston calls for delay in introducing Accountable Care Organisations, I have submitted evidence about Devon’s Accountable Care System to the parliamentary enquiry

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Sarah Wollaston, the chair of the Commons Health Committee, has written to the Health and Social Care Secretary urging him to delay a new contract for Accountable Care Organisations (ACOs), due to be implemented nationally later this year. She claims there is a “great deal of concern” over the plans which she considers “have not been well aired publicly up until now”.

This is precisely the point which I have made about Devon’s Accountable Care System -intended I believe as a precursor to Accountable Care Organisations – which is due to begin on 1st April. Neither Devon’s Health Scrutiny Committee nor the public has been made aware of this, and what it involves is still unclear.

I have submitted the paper – with 8 key questions – which I prepared for Health Scrutiny on Thursday to the parliamentary Health Committee’s Sustainability and Transformation Partnerships inquiry. Thanks to Mike Allen for drawing my attention to this just before last night’s deadline for submitting evidence.

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