Explained: Accountable Care and Integrated Care Organisations

The government's latest change to the NHS is already stirring up huge controversy. When plans to introduce Accountable Care Organisations first emerged, health campaigners quickly found connections between these new organisations and bodies of the same name that exist in the United States.

Accusations were made that ACOs signaled a radical move towards an insurance-based system. A court case against the government was launched involving one of the plan’s most prominent critics, Prof Stephen Hawking, which has forced the government to announce a pause, to consult with the public.

So what’s behind the controversy and how could Accountable Care Organisations affect the NHS and our healthcare?

Put simply ACOs bring together all the NHS services in an area under one contract and under a single fixed budget.

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These huge contracts can be awarded to an NHS organisation, a third-sector (charity/not-for-profit) or a private for-profit company. Which is where some of the controversy comes from as it would be possible for a company like Virgin Care, which already has many NHS contracts to take on this major role, but so far no ACO contracts have been signed with any organisation - public or private, although two international health firms, Centene and United Health have shown interest in helping to develop them.

At present, health and social care are co-ordinated through hundreds of different contracts and are paid for out of two separate budgets; health is paid for by the NHS and social care and public health are paid for by local authorities or by means-tested charges. The Government's plan is to integrate these services.

There is little debate about the fact that there could be huge benefits from getting health and care services to work closely, merge or integrate. It has been a desirable aim amongst policy makers for many years. It is hard to achieve, but there are some examples in the NHS already, but not by using ACOs. Accountable Care Organisations are a very different brand of integration and raise some serious questions which have yet to be answered.


Five key concerns with this version of integration

1. Why rush forward with ACOs when there is yet to be any real evidence that they will work? It is only 5 years since the last major re-organisation, which has been widely criticised.

2. Why allow private companies the opportunity to take control of such a major role? Their record in running NHS services included many examples of contracts that have failed. If this is not the intention why not just rule it out

3. What happens when ACOs run out of money, who goes without care and how is this decided?

4. Surely ACOs are destined to fail unless proper funding is restored, the same is also true of any other form of integration.

5. Does this version of integration really fit with the key principles of the NHS - eg How can we make sure that healthcare remains free at the point of use, when more of it will be provided in the community where means-tested social care already exists?


What's happening now?

So far the evidence of the effect of ACOs on quality is contested, and at best mixed - Prof Allyson Pollock

ACOs have made the media recently due to two legal challenges. As a result of these legal challenges and questions from MPs, in January 2018, NHS England announced that a 12 week consultation on ACOs will take place and the process of ACO implementation was effectively paused.


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