Workers' Weekly On-Line
Volume 48 Number 20, June 30, 2018 ARCHIVE HOME JBCENTRE SUBSCRIBE

70th Anniversary of the NHS

Accountable Care Systems and the National Health Service

From Short Briefing by Keep Our NHS Public, January 20, 2018

As little as five years since the massive restructuring imposed by the Health and Social Care Act (HSC Act) of 2012, the NHS is again undergoing radical change, this time at reckless speed and without public or parliamentary consent.

Recent changes by NHS England (NHSE) divided the English NHS into 44 local health systems or "footprints" (now "Sustainability and Transformation Partnerships"). Each of these is required to integrate its local health and social care services through crossboundary working and pooled budgets.

These changes, relying on collaboration between healthcare providers within a "footprint", currently run counter to the Health and Social Care Act of 2012, which sought to increase competition.

Now, further developments in 2017 mean that ST Partnerships are required to deliver "accountable care" by morphing into Accountable Care Systems (ACSs), with the aim of eventually becoming Accountable Care Organisations (ACOs). ACOs are non-NHS bodies, "designated" by NHSE, despite the absence of any statutory authority.[1] Behind the rhetoric of replacing competition with collaboration, NHSE intends to substitute the current system of procurement with one inviting tenders for a single, long-term lead ACO contractor for each region, empowered to decide both the location and nature of services.

These developments are influenced by thinking from the World Economic Forum (WEF) that favours governments cutting back on public services and giving corporations a greater role. The WEF argues that the costs of national health systems like the NHS can be reduced by introducing new models of care - accountable care systems - that "integrate" services, reduce hospital capacity and expect individuals to provide more "self-care".

From the photographic exhibition available for hire by KONP and other NHS campaign groups. Contact:

NHSE argues that introducing "accountable" or "integrated" care is central to Government aims for the "financial sustainability" of the NHS. In this context, "sustainability" means reducing services to match insufficient funding. Despite being one of the richest countries in the EU, GDP spending on health care per person in the UK is below EU-15 averages.[2]

Accountable care systems (i.e. both ACOs and ACSs) need to be opposed for the following reasons:

No one can deny that acute, primary care and community NHS services and social care need to be better coordinated. However, this does not require commercial contracts and the involvement of corporations.


See (Select: Accountable Care Organisations and Systems) and KONP website at for more information


4: There have not been actual cuts in total NHS funding since 2010 - funding has risen very slightly in cash terms. However, the rise has been far slower than the growth of population need and cost pressures. £22bn is the gap between the virtually frozen funding for 2015-2020 and the steadily rising costs and pressures, and that implies "savings" which must amount to cuts.


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