ACOs, an issue nobody wants to talk about, but I'm going to anyway...
Well, I've just got back from the STP public debate organised by Healthwatch Lancashire in Leyland. Healthwatch invited clinical leaders working on the STP to the event so the 'leaders' could explain what the Sustainability & Transformation Partnerships (STPs) were all about and what the STP plans involved and how they 'might' work.
I asked why the name was changed from ST 'Plans' to ST 'Partnerships' since when the public were taking part in the engagment events they commented on plans, not partnerships. The answer was the plans are now partnerships and all healthcare providers now intend working together. Not really a justification is it? Ah, so this is the Accountable Care Organisation (ACO) Partnerships I offered.
So we all sat patiently waiting for how these ACO partnerships were going to work, how they would be funded, where staff would come from, and see some evidence of an ACO being beneficial to patients. It never came.
In fact, around 70 minutes into the 2 hour session I had to ask the STP lead doing most of the talking 'Dr Amanda Doyle' why she or her team hadn't mentioned the ACOs (which is what all STPs are to become), and only then got a brief mumble about working together etc,, no mention that ACOs work on capitated budgets and 'demand management' (restricting demand to treatment and medicines by limiting access to healthcare).
But what really plagued my mind was what Dr Doyle said in response to a question from a member of the public about the NHS being privatised. She came out with the old chestnut that the NHS already has private practice GPs and have done so for many years. No problem with that since the GPs work for the NHS indirectly via their contracts. But on closer thought consider this......
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Here we have the lead organisor of the Lancashire STP (also Blackpool CCG) Dr Amanda Doyle, a PRIVATE practice GP. Rolling out plans that were put together by the boss of NHS England 'Simon Stevens' the ex vice-president of the largest PRIVATE healthcare company in the U.S. (UnitedHealth), who in turn was appointed by the Health Secretary 'Jeremy Hunt' who openly stated in a policy pamphlet the NHS was an arcahaic institution and called for it to be 'denationailised' (privatised).
The in-depth issue of ACOs and how they work were seemingly avoided by the panel at all costs. But I think you get the picture, and of course one of the reasons the Tories wanted private practice GPs to sit on Clinical Commissioning Groups (CCGs) and be put in charge of the biggest chunk of the NHS budget.
There has been no asessment on the impact the 'challenging' changes will have on patient care, only talk of improvements in services and care closer to home. Again no answers to where the funding is coming from, where the staff are coming from, or where the evidence is that care pathways such as 'preventive/self care' will reduce the financial burden. Although Dr Doyle claimed IF it did work it would reduce the NHS budget by a big chunk. It's been tried before and never worked, and no evidence was provided tonight. But one thing is for sure....
OUR HEALTH - WHO CARES
They are willing to role the ACOs out on a 'trial basis' (suck it and see), STP leads and clinicians have been told it's OK to fail but "we must get on and do something" and to be less risk averse [take risks] and not [be] afraid to try something new [1].The risks in such partnership plans are very high, and many patients will suffer if anything goes wrong, yet those implementing the STPs have been told to go ahead and do it anyway.
What they plan to do..
The Solution Design Event Team in July 2017 made some proposals based on feedback from 3 public engagement events (called 'Our Health Our Care) to meet the out of hospital strategy (effectively denying hospital care to patients).- Transfer services into communities (this is what I call 'Primary priming' ready for the privatisation or the take-over of primary and community services).
- CLOSE at least 80% of Hospital outpatient services and move them into clinics (this is decoupling of services from the hospital ready for take-over by the likes of Virgin care - this will be a PPP 'Private-Public Partnership to start with).
If the GPs don't agree to be part of the GP federation (i.e. one of the ACO partners), then the ST Plan could fail. Same with other proposed 'partners' such as social care (Better Care Fund). And if any one of the partners refused to join the ST Partnership ACO? or what if a partner decides to leave? or Who's running the show (governance structure?).. Again, no answers to these questions from the panel at the public meeting in Leyland.
When faced with the reality of what could happen (what if scenarios).
When faced with questions they couldn't answer, the questions were seemingly avoided and a reply of how lovely it would be IF it all did work.
So there are no answers. ACOs are a spin-off from Obamacare and are simply an extension of Health Maintenance Organisations that are demand led, capitated (restricted) budgets, and have never been trialled in a system where taxpayers money would be thrown at it (the U.S.A. medicaid ensures customers make co-payments if they exceed a certain treatment cost).
There are always two sides to a debate but unfortunately, when the reality of what could happen is ignored the inevitable happens. It's time to wake up everyone about what's happening, before it's too late....
[1] 'Solution Design Events' July 2017 proposals
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STP Lead Dr Amanda Doyle claims STPs are meaningless to public
