NHS plans in court

A Hebden Bridge campaigner is launching one of two legal challenges to the government over its plans to introduce new NHS organisations she says could threaten patient safety standards.

Representing campaign group 999 Call for the NHS, Jenny Shepherd will tell a judicial review at Leeds Crown Court beginning on 24 April that government plans to launch what it originally called accountable care organisations (ACOs) are unlawful.

ACOs bring together different healthcare providers in a local area, with the aim of providing a more coherent, integrated service that also focuses on the causes of ill health.

They are being piloted in 10 areas in the country, including Greater Manchester – through its devolution programme – Blackpool and Fylde, and South Yorkshire and Bassetlaw.

But ACOs are paid a fixed sum for the total number of healthcare interventions – such as operations – they provide. Campaigners fear this means quality will be cut if demand for those interventions is higher than anticipated, or that public money will be wasted if demand is lower.

It is on this point that Shepherd’s judicial review will be conducted.

“ACOs will treat patients based on cost,” claimed Shepherd. “People working will get better treatment. Elderly people whose life could be improved by a hip replacement will only get it if the budget exists.

“ACOs can retain any monies not spent annually. This will incentivise them to save money.

“An ACO seeking to break the budget will see NHS England send in the auditors to impose restrictions. ACOs mean the NHS won’t be providing comprehensive care or a full range of services.

“The current lack of a legal framework, especially around payment methods, is incompatible with democratic control.”

The second legal challenge is being mounted by the JR4NHS campaign group, which until his recent death included Professor Stephen Hawking.

According to Allyson Pollock, professor of public health at Newcastle University, who is part of the challenge team, ACOs are “modelled on American ACOs, where providers can be public and/or private bodies including healthcare organisations, health insurers and property companies. The UK government is planning to bundle up billions of pounds worth of funding and give ACOs contracts for 10-15 years. Such changes could threaten the whole basis of universal health care and the principles of the NHS.”

The government announced the introduction of ACOs – which it has now renamed integrated care systems – as part of NHS England guidelines in 2015 to improve the quality and efficiency of health and care services. It has agreed not to introduce them formally until a consultation has been held but JR4NHS insists parliamentary scrutiny is needed as well.

“Under the mantra of service integration NHS England and Jeremy Hunt are putting in place shadowy new structures whose names keep changing, from accountable care systems and integrated care systems to integrated care partnerships,” said Pollock.

“None of these have been debated and scrutinised by parliament. They are poorly understood.

“This is not only undemocratic, it exposes the huge democratic deficit now at the heart of our society.”

Shepherd hopes that a legal victory would mean the end of ACOs but, if not, that it would require primary legislation to introduce them, “rather than rely on secondary instruments whereby public bodies are less accountable and can break the law with impunity”.

Photo: Jenny Shepherd says the lack of a legal framework around ACOs is incompatible with democratic control