The End of the Nye

Professor Allyson Pollock, a senior consultant in public health medicine, gets far less public recognition than she deserves, because she has a track record of being right and spotting disasters long before anyone else has woken up. She was a fierce critic of the internal market introduced into the NHS by the Conservatives in 1991, arguing rightly that it would be wasteful and inequitable, and had no evidence base. In 1995, she pointed out the dangers of the NHS abandoning long term care of the elderly and farming it out to means-tested social care that transferred the costs of care, and the fear of paying for it, from society to the individual (precisely what Bevan was trying to reverse when he established the NHS 70 years ago) 

In 1997, Pollock was one of the first to highlight the lack of transparency, inadequate risk sharing and unaffordable long term costs of Private Finance Initiative projects, which are now crippling many hospitals. And she immediately saw through Andrew Lansley’s disastrous Health and Social Care Bill, campaigning vigorously for an NHS Reinstatement Bill that would restore the duty of the Health Secretary to provide universal care, rather than just ‘promote’ it, and end the massive waste and fragmentation of re-tendering community contracts every few years and outsourcing them to for-profit private companies.

With health secretary Jeremy Hunt and NHS England CEO Simon Stevens locked in a Mexican stand-off over whether the NHS has sufficient staff and funds to provide safe, timely universal care (it doesn’t), Pollock is again focusing on the policy, trying to enforce proper consultation before the English NHS rushes headlong into its latest ruse of US-style Accountable Care Organisations (ACOs). Hunt and Stevens hope to change secondary legislation to enable ACOs to operate in England but have consulted on technical changes only. In US ACOs, government and private insurers award contracts to commercial providers to run and provide services in defined locations, and thus far they have not produced great savings or massive improvements in care, although the idea of dissolving the boundaries between health and social care, and joining services up is a seductive one. 

In theory, a small number of very powerful English ACOs could be given multi-billion health and social care budgets, running the entire service for 10 or 15 years. Will they have the power to introduce more charges and erode universal care? Could entire ACO contracts be outsourced to the private sector, now or in future? ACOs are not recognised in the UK, and given the turmoil of Brexit, Hunt and Stevens are trying to rush them through without proper scrutiny or primary legislation, which would have to pass all parliamentary stages.

Pollock argues that ACOs ‘will be non-NHS bodies “designated” by NHS England, even though there is no statutory provision conferring such a function on NHSE. Behind the ACO it appears that there will be a network of companies—providers, subcontractors, insurance companies, and property companies—but the consultation is silent on ACO membership or their contractual relations. According to NHSE, ACOs will be in charge of allocating resources—effectively deciding which services are provided and to whom; which services are available free, through insurance, or out-of-pocket payments; and which services are to be means tested. They can take over patients on GPs’ lists, and they can subcontract all “their” services.’

Hunt and Stevens will doubtless try to ignore Pollock, so she and her supporters have recruited Stephen Hawking and filed a case in the High Court seeking a judicial review ‘to stop Hunt and NHS England from introducing new commercial, non-NHS bodies to run health and social services without proper public consultation and without full Parliamentary scrutiny.’ If Hunt and Stevens have nothing to hide, they would surely welcome the chance to set out their proposals openly and clearly in a White Paper, and to invite wide public and professional responses. And now that Parliament has woken up to its power, it could put Brexit on hold and focus on keeping the NHS honest. Just as not all NHS trusts can be trusted, accountability doesn’t just happen if you call an organization ‘accountable’.

You can support of donate to Professor Pollock’s campaign at @jr4NHS