2 December 2017
A major reorganisation of the NHS and Social care is being proposed for Somerset- but without consultation or information for the public. In July 2017 Somerset Clinical Commissioning Group and Somerset County Council Cabinet agreed to develop joint commissioning and have now agreed to develop one Accountable Care System for the county by 2019. Who will be in charge of this system and what is it likely to mean?
Accountable Care Organisations (ACOs) are an American concept intended to stem rising healthcare costs In America contracts for ACOs are awarded to commercial providers to run and provide services.
In England ACOs will be non-NHS bodies, “designated” by NHS England. ACOs will be in charge of allocating resources, (which we know are currently insufficient for demands)’ deciding which services are provided and to whom; which services are available free, through insurance or out-of-pocket payments; and which services are to be means tested. They can take over patients on GPs’ lists, and they can sub contract all “their” services. A Somerset ACO could be given the multi-billion pound health and social care budget, including those for GPs and public health, for up to 10, or possibly 15, years. If this is not concerning enough, the boundaries between health (free at the point of delivery) and social care (subject to means testing and user charges,) could become increasingly blurred which has implications for the availability of free health services. As the ACO is almost certainly not going to be a public body, there will be no transparency as such contracts are deemed commercial and confidential. They will not be subject to Freedom of Information requests.
The 2012 Health & Social Care Act made a legal shift from the Secretary of State having “a duty to provide” to Clinical Commissioning Groups having a “duty to arrange provision” . This is standard legalese for outsourcing.
Some elements of NHS provision were transferred to Local Authorities which has led to reduced services and entitlements, and more private provision of publicly funded services. This does not bode well.
Is this the direction of travel that the people of Somerset want? It appears to me that we are moving rapidly towards an American style of health care - which is what the private sector are lobbying for and which Jeremy Hunt advocated many years ago.
Alison Barkshire, East Mendip Green Party
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