A parliamentary report has refuted claims that the move towards integrated place-based care across the NHS will result in creeping privatisation of the health service.
Campaigners have argued that new management structures — such as accountable care organisations (ACOs), which provide healthcare for whole local populations over a period of 10 to 15 years — could be taken on by private sector companies winning the contracts.
In January 2018, Sarah Wollaston, chair of the cross-party Health and Social Care Select Committee (HSCC), wrote to health secretary Jeremy Hunt asking him to delay the introduction of a new contract for ACOs because of concerns over the policy.
But the HSCC’s own report, ‘Integrated care: organisations, partnerships and systems’, published on 11 June 2018, said there were several reasons why it was unlikely that a private provider would hold one of these contracts.
The report says that ACOs, who would merge the provision of acute, community, primary, mental health and social care for one area, were much more likely to be “credible providers” if they had some NHS experience because of the scale of the job the new organisations would have to do.
“We recognise the concern expressed by those who worry that ACOs could be taken over by private companies managing a very large budget, but we heard a clear message [in evidence given] that this is unlikely to happen in practice,” the report said. “Rather than leading to increasing privatisation and charges for healthcare, we heard that using an ACO contract to form large integrated care organisations would be more likely to lead to less competition and a diminution of the internal market and private sector involvement.”
The report added that ongoing reforms in health and social care, such as the establishment of place-based care organisations where one organisation manages all elements of care in one area, should be better communicated to the public.
It said that while the move towards integrated place-based care could improve the delivery of healthcare and help address “wider social problems” by providing more integrated care, there has been confusion about what such moves actually are and are intended to achieve thanks to poor communication.
The report also criticised the use of jargon by policymakers developing the new NHS structures and said: “Changing acronyms, titles and terminology have allowed misunderstanding to fester and suspicion of the underlying purpose of reform. Representatives from the health and care community — the NHS, local government, professional bodies, patient groups and the voluntary sector — [should] lead on the development of new legislative proposals for the government.”
However, pharmacy is not explicitly named among those professions working on such plans.
The report also stressed the scale of such ambitious work has not been matched with “the time and resources required to deliver it”. “Countries that have made the move to more collaborative, integrated care have done so over 10 to 15 years and with dedicated upfront investment,” it says.
Commenting on the report, Richard Murray, director of policy at the King’s Fund, said: “This report nails the myth that the health service is on a path to privatisation and provides cross-party support for a vision of the NHS based on collaboration, not competition.
“We know from our work that new ways of providing integrated care are beginning to make progress in improving services for patients. The challenge now is to accelerate the pace of change so we welcome the recommendation for a new strategy to transform services — as the report makes clear, this must be backed by dedicated funding and a clear and compelling case for change to engage patients and the public.”
A statement from campaigning group Keep our NHS Public, which is among the organisations that have warned of the threat of privatisation, accused the HSSC’s report of “defending” a healthcare policy that was “dangerous in bringing in models of care based on the deskilling of a workforce designed to give cheaper, underfunded care in the community”.