A 999 Call for the NHS resource
Accountable Care Organisations
a route to stealth NHS privatisation
Accountable Care Organisations (ACOs) will be handed most of the budget for area’s health and social care, to be provided by NHS, local authority, private and third sector companies - all partners in the ACO. So ACOs amount to a private-public partnership - like PFI, but for health care services as well as buildings.
Like PFI, it seems they will be run through a Special Purpose Vehicle - if the Northumberland Accountable Care Organisation, which will go live in April 2017, is anything to go by.
Its Special Purpose Vehicle will handle the Clinical Commissioning Group’s and primary care budgets and nearly all the functions of Northumberland Clinical Commissioning Group.
So what is a Special Purpose Vehicle? According to Investopedia a SPV is:
STPs intend to turn the NHS into a copy of the US Medicare system - a publicly-funded, insurance-based system that buys care from private health companies, for those who can’t get private health insurance.
An end to the NHS as a comprehensive health service
that provides healthcare to us all, based on our clinical needs
The STP system undermines the basic principle and obligation of the NHS: to provide appropriate treatment based on clinical need to everyone who comes through the door.
Instead, STPs aim to create a health service that operates on a fixed budget, (based on a set amount per head of the population in a designated area) and “manages demand” to make sure that it limits numbers of patients and the treatments they receive to what is affordable on this fixed per capita budget. Affordable meaning some room for profit too.
The STPs describe these systems as “place based care” “capitated payment” and “demand management”. They don’t explain that this mean-spirited restriction of treatments and patient numbers is based on an American health insurance system variously called managed care, health maintenance organisations or accountable care organisations.
How Accountable Care Organisations (ACO's) work
An Accountable Care Organisation (or System now also called in 2017) is accountable to the health insurance company that holds the budgets for treatments available to the population that is covered by the ACO . This is usually around 50K people - compare this with the 2k-6K population that is usually registered with a UK GP surgery. Don't be fooled by the word 'accountable' in this contect. It means counting money not BEING accountable to the public.
The health insurance company specifies what treatments are available (managed care) and which patients can access them (the ones who are cheapest to treat and who offer the best chance of financial recovery), as well as setting the overall annual population budget that the ACO has to stick to.
If the ACO comes in under budget it can keep what it hasn’t spent so there is incentive there to restrict treatment in order to maximise profit. The spin from NHS England is that this incentivises efficiency. The reality is it leads to cherry picking patients and restrictions and denial of care. This is called ‘demand management.’
STPs and ACOs are ALL ABOUT 'Demand Management'.
By imposing managed care pathways - ie telling doctors what treatments they can provide and how to provide them - Accountable Care Organisations de-professionalise doctors and other health workers and destroy the individual patient- health worker relationship.This is clearly not the NHS as a publicly owned, funded and run comprehensive health service, or as an empathetic, person-centred health service.
“a subsidiary company with an asset/liability structure and legal status that makes its obligations secure even if the parent company goes bankrupt. An SPV/SPE is also a subsidiary corporation designed to serve as a counterparty for swaps and other credit sensitive derivative instruments. Although the SPVs/SPEs are used to isolate financial risk, due to accounting loopholes, these vehicles may become a financially devastating way for Chief Finance Officers to hide debt, as with the Enron bankruptcy.”
Back in the USA - things have never been worse
SO... SPECIAL PURPOSE
Linda Peeno, whistle blower for the US ‘managed care model’, said in 2009
“Things have never been worse for patients. The corporate machines are well-developed and expertly operational. The methods are more insidious, covert and devious. In addition to outright denials of care, new tactics proliferate to avoid, delay, limit, substitute, and manipulate care for the maximization of profits. ”
Regardless, this US health care system is the chosen destination for the NHS as far as the STPs are concerned
But we the people have other ideas...
Slash Trash Privatise
Switch To Private
Secret Theft Plan
Made a fanfare speech this week in Yorkshire saying if elected,
he would "Stop'n'Search" the STPs - halting and reviewing them before they continued.
That's missing the point.
Find out more and what Aunty STP thinks we need to do.
Jonathan Ashworth MP
Shadow Sec. for Health