Up-to-date info about the current “Integrated Care Systems” is located here
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“Sustainability and Transformation Plans” (STPs) and
“Accountable Care Organisations” (ACOs)
STPs, ACOs and ICSs – the shifting sands of NHS privatisation
Sustainability and Transformation Plans (STPs) were introduced by the Conservative Government in 2017; this reconfiguration involved dividing England into 44 geographical “footprints” within which providers and commissioners (including, on paper at least, Councillors) were asked to work together to address the NHS Five Year Forward View. Accountable Care Organisations (ACOs) and Systems (ACSs) were seen as a progression of this initiative where, according to NHS England, “an ACS will be an evolved version of a STP that is working as a locally integrated health system”NHS England, 2017
Accountable Care involves the payment of a group of organisations to work together to look after a whole population – the inhabitants of a city, county or “footprint” – and paying that group of organisations per head. A phrase used during the instigation of this approach in New Zealand was “one system, one budget” Charles, A, 2017
Whilst the stated aims of developing STPs and ACOs in the UK included health promotion, community based provision, collaborative working and cost effectiveness – all of which (on the surface, at least) are credible aims – it immediately became apparent that the approach of the Government aligned more with privatisation and cost-cutting agenda’s. This included awarding large commercial contracts for hospital, community and general practice to private businesses and corporations such as Virgin Care, Care UK, and HCA; services such as ambulance, laboratory, cleaning and IT were also increasingly outsourced.
This competition for contracts inevitably leads to aggressive cost-cutting, with loss of services and deskilled, poorly paid and demotivated staff. However, the advent of “Accountable Care Organisations” brings the additional risk of wholesale NHS privatisation by the tendering of a single massive contract to run all of the hospitals, community services and, sometimes, social care services in one geographical region or “footprint”. Likely bidders include US healthcare giants and, equally deadly, private – public partnerships between finance corporates and NHS Trusts. Kaiser Permanente is associated with the term “Accountable Care Organisations”, providing healthcare in the States on a private insurance basis.
Whilst the Government had spoken about the creation of Accountable Care Organisations across England, the term quickly became problematic, probably because of the US associations and the activity of Campaign groups, plus two high level legal challenges (see below) . Eager to separate from and shake off this association with ACOs, NHS England rebranded ACOs as Integrated Care Systems (ICSs) – see our ICS website page here
So….is it STP? ACO? or ICS? If you get these terms mixed up, then you won’t be alone… and the easiest way forward is to consider them one and the same, with ICSs being the latest and current term in vogue. STPs are now very rarely mentioned, and the term ACO is very swiftly brushed under the carpet by NHS England.
One final issue – although the Government is pushing for the establishment of 42 Integrated Care Systems across England by 2021, at present they have no legal standing – hence the White Paper (2021) and the proposals to give ICSs statutory powers and responsibilities. Government spin suggests the White Paper proposals will “reduce the role of the private sector and scrap a system of contracts being put out to tender that has seen health groups competing against each other”. Instead, the White Paper suggests that the NHS and local authorities would be left to run services and work together. NOTHING COULD BE FURTHER FROM THE TRUTH. The proposals for ICSs will further fragment the NHS, bring major corporates into the heart of NHS management and bind local authorities, especially social care, to NHS priorities. This will destroy our NHS. We need to restore our NHS as a publicly planned, run and publicly owned NATIONAL service, funded through taxation
Please go to our ICS website page for detailed information incl leaflets, articles, model motions, petitions and a map showing the geography of the “North East and North Cumbria Integrated Care System”.
THE PROPOSALS IN THE WHITE PAPER 2021 MUST BE STOPPED.
Local and national NHS documentation relating to STPs and ACOs
Presentation to North East Joint STP Health Scrutiny Committee by Amanda Hume, Executive Lead for Transformation and Strategic Commissioning (Jan 2019) – click on item 5 An Aspiring Integrated Care System
April 2017 Guidance from Newcastle City Council’s “Wellbeing for Life Board” about the “Communities and Neighbourhood model” ishereThis paper proposes ways in which the STP may fit within organisational structures.
Draft Northumberland, Tyne, Wear and North Durham Sustainability and Transformation Plan (Nov 2016) Full document: NTWND-STP-final-submission-combined
The NHS England webpage which provides links to associated operational documents is here
NHS England guidance on engagement and consultation re STP’s (Sept 2016):engag-local-people-stps
Legal Challenge to the ACO’s number 1 (2018): 999 Call for the NHS is here
Working with public law firm LEIGH DAY, 999 Call for the NHS believe that the ACO contract is unlawful under current NHS legislation, on the grounds that the contract does not link payment to the number of patients treated and/or the complexity of the medical treatment provided. It fails to ensure that there would be sufficient money to meet the cost of delivering NHS services to the required quality standard.
Legal challenge to the ACO’, number 2 (2018): Judicial Review for the NHS (JR4NHS) is here
Working with public law firm LEIGH DAY, the JR4NHS team believe that ACOs would fundamentally change the NHS and many private businesses could profit from this radical reorganisation of health and social services. These private businesses would have control over the allocation of NHS and taxpayers’ money. Their accountability for spending it and their obligations to the public would be under commercial contracts, not statutes. This is not in the public interest. It is also against the public interest that ACO’s are being introduced by stealth, without proper public consultation and without full Parliamentary scrutiny.
Parliament debates the e-petition on NHS Privatisation (April 2018):
Petition: Stop the privatisation of NHS services
We call for a ban on the outsourcing (privatisation) of NHS services, and stop the renewal of any outsourcing contracts already signed. Companies should not be profiteering from NHS contracts, when every pound of NHS budgets is desperately needed for more doctors and nurses, and to pay them more.
Research by Bain & Company published by the Financial Times in January 2017, found that private-sector companies had been invited to bid for 14 per cent more NHS contracts in the 12 months to August 2016 than just a year previously. In March 2017 the Financial Times also reported of the extra £2bn given to the NHS in 2014 to try and bolster NHS services, according to data analysis carried out by the Health Foundation, an independent charity, only about half this extra money was spent in the NHS.
Jonathan Ashworth identifies serious concerns re STP’s and ACO’s: Changes regarding healthcare provision must be debated and voted in Parliament New Statesman 8.12.17
