Up-to-date info about the current “Integrated Care Systems” is located here
“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.
….and hear Hunt speak about the shift from the title “Accountable Care Organisation” to “Integrated Care System” – shameful.
Incidentally, the perceptive follow-up video featuring Prof David Himmelstein was filmed by KONPNE in October 2017, at the event at Newcastle University hosted by Prof Allyson Pollock
STP’s and ACO’s – past Campaign information and links 2016 – 19
General information re STPs and ACOs
National KONP STP’s: What you need to know
Carol Ackroyd FAQ’s about STP’s
Patients4NHS Information sheet
Unite the Union Mythbusting: STP’s
Centre for Health and the Public Interest STP’s: Five Key Questions for Planners
London South Bank University STP’s: How serious are the proposals? A critical review
The Centre for Health and the Pubic Interest (January 2017) – article by John Lister, Health Campaigns Together STP’s: A Critical Assessment
The Centre for Health and the Public Interest (October 2017) Unaccountable Policy Making for the NHS in England
Public Matters (Feb 2018) Will the written evidence to the Health Select Committee bring about the end of the Sustainability and Transformation Plans?
October 2019 KONPNE Briefing Papers on ACOs and ICSs (for public use, plus copies sent to all Councillors in NE)
Accountable Care Organisations and Integrated Care Systems 2019 KONPNE briefing – ACO and ICS