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I remember when I first heard the term STP; I was portfolio holder for adult services at the time, and while I supported the need for a better integrated health and social care system, there were no details of what this might mean in the future. Within a few months, NHS bosses started talking about accountable care systems and accountable care organisations. Bedford, Luton and Milton Keynes would become a “first wave” accountable care system and this was good, they told us. The decision to become a “first wave ACS” had to be taken within 24 to 48 hours to secure additional funding, so there was no time for consultation with other councillors, let alone the public.
The same approach was taken with the STPs: no or little consultation with a take-it-or-leave-it funding deal, with no time given to us to analyse or debate the pros and cons. Recently we learned that the three CCGs in our STP area have agreed to merge their executive functions, which was “nothing to do with MPs and councillors,” they said, and nothing to do with the public. But they cannot tell us who will be accountable under this new structure, and it is likely that it will not be the people making decisions about our health and social care system.
The term ACO emerged in the US in 2006. ACOs were designed to improve patient experience and control federal expenditure within the US healthcare system, which is dominated by private health and insurance companies. But so far the evidence of the effect of ACOs on quality is not convincing and in fact spending has increased.
There is an inherent risk that if we invite tenders from providers to run health and social care systems across the country, and we do so without proper consultation with patients and service users, we will end up with the sort of mess that we saw at Hinchingbrooke Hospital and hospitals suing the NHS as Virgin Care did but on a much larger scale.
The Government’s healthcare reforms of 2012 have created chaos in our health service. We now have a system that allows private providers to escape necessary scrutiny when they get things wrong and to walk away from unprofitable contracts without reproach. Billions of pounds have been wasted that could and should have been invested in frontline care.