News and Comment from Roy Lilley.

They don’t make their cars like they used to.  They make great wine.  They have strange taste in politicians and their healthcare system is different to ours.

No, not Italy.  I’m talking Trumpsville.

Their health outcomes… some of the best in the world.  However, despite the best efforts of Barack Obama and you know who, dabbling, there are still millions of Americans with no, or very poor healthcare.

They don’t have a universal, equitable NHS.  Very few places do.  Comparing the NHS is tricky.  Measured on access and equity, the NHS does well in the Commonwealth Institute survey.

Outcomes?  We are not the best across the board.  Collectively, at the high-end but not universally the best.  Comparisons, even across Europe, are difficult.  Data collected differently, death certificates not always public documents.

The important thing; keep an open mind.  Accept that we have something to learn from everywhere, despite the ‘payer’ system… taxes, co-payments, insurance.  Public or private.

We have copied bits of the CCG system from Denmark.  We are about to copy  some of Holland’s Buurtzorg… a private company. We copied Foundation Trusts from Spain.

Next; Accountable Care Organisations.  They are an American construct.  Been around for a while.  Kaiser Permanente originated them, but came to the fore in the Obama-Care days; Medicare ACOs an attempt at integration, better care and a handle on costs.  With mixed results.  Here and here.

England has 7 underway.  An example; The Northumberland ACO.  Comprising; Northumbria FT, Northumberland CCG, Northumberland CC, North East Ambulance, MH Services, GPs, patients and the HWB.

Local organisations, working as an integrated system, with collective responsibility for resources and population health.  Working vertically and horizontally, virtually or through actual mergers or GP hubs. 

Old enough to remember District Health Authorities?  It’s one of them on steroids.  

The question occupying people, most of whom are supplying their own answer; ‘Is it a stealth move towards privatisation.’

I’ll come back to that.  First a bit of explanation.  The dysfunctional mess, Lansley’s legacy, left us with; distributed responsibilities, no system-wide leadership and no strategic overview.  Chaotic commissioning, based on 212 organisations with all their interfaces and costs.

Plus, a 360 page Act; impossible to unpick now that Brexit is preoccupying Parliament.

Dumping CCGs and commissioning is a sensible idea.  Moving to a whole system, population based, capitated budget brings a collective sigh of relief.

Achieving it will require some technical changes to make someone legally responsible for syndicated budgets and if GPs join in, as they are the private sector, changes and suspension of some of their contract clauses.

Back to privatisation.  Meaning;

‘…the transfer of assets from the public (government) sector to the private sector.’

… not to be confused with ‘contracting out’.  Meaning; third parties, NHS, voluntary sector or private, running a service.

Remember Hinchingbrooke?  Circle ran it, ran out of money and ran away.  We still own the hospital.  It was contracting out.  Virgin?  Ran into trouble in Surrey, ran to the High Court and have run out of friends in the NHS.  Contracting out.

Are ACOs contracting out?  No.  Are they privatisation?  No.  They are a system.  Is it possible that, over the long-term, they could be run, under contract by the private sector?  Maybe, if the organisational structures were consolidated, if all the parties agreed.

Bear in mind;  FT’s could be sold-off.  We are half-way there with PFI.  Ambulance services, with their identifiable asset-base could be flogged, lock, stock and blue light.  NHS Blood and Transplant could be sold.  Path-labs, easily.

If Parliament so decides; anything can be flogged off.

Why the row over ACOs?  We had the same argy-bargy over Trusts.  There were those convinced they would be sold.  PCTs, accused of being a stepping stone for Kaiser to sweep in.

The great thing about the NHS is that for every £1 of taxes you get £1 of healthcare.  In the private sector you might get 60p, the rest goes on loans, dividends, fast cars and franchise fees to a bloke who lives, tax-exiled, on an island.

We don’t want that.  But we do want ACOs.  One does not necessarily mean the other.


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