Hello Friends

As a backer you know our Judicial Review, challenging NHS England’s contentious Accountable Care Organisation contract, will be heard on Tuesday 24th April at Leeds High Court, 1 Oxford Row Leeds LS1 3BG

We’d like to invite supporters and fellow campaigners to a rally outside the courts from 9. 30am, to support the vital NHS principles our Judicial Review aims to defend. We will be inviting Press & Media.

This week we had a really good meeting with our legal team from public law firm Leigh Day and Landmark Chambers, to discuss the ‘skeleton case’ – a summary outline – which is due to be sent to the court in the next few days.

The skeleton case is based on our deep concern that the payment mechanism proposed for the Accountable Care Organisation contract is not only unlawful under current NHS legislation – but will lead to restrictions and denial of NHS care, and the abandonment of the core NHS principle of providing comprehensive care to all who have a clinical need for it, free at the point of use.

This would mean replacing treatment based on patients’ clinical need with treatment based on assessments of financial risk and returns – a total departure from core NHS principles, replacing them with health insurance company principles.

This is because the Accountable Care Organisation contract requires NHS commissioners to pay a fixed lump sum to cover the whole range of services for the population in a given area – rather than the present system which pays NHS providers an agreed price for the treatments they have actually delivered to patients.

Without reference to the number and complexity of treatments delivered to patients, the ACO contract’s proposed fixed population payment would pass financial risk to the providers – and from providers to us the patients.

Why? Because if providers were to get more patients needing more complex treatments costing more than the fixed lump sum they receive, they would face spending money they don’t have. They’re not likely to want to do that. The only way to avoid that would be to restrict or deny patients’ access to treatments. Particularly patients whose treatments are more costly and whose prognosis means their treatment is not such good value for money.

In our view, NHS England is playing fast and loose with existing NHS law about how prices are set and payments are made for health care provided to NHS patients.

Although we don’t in any way support the 2012 Health and Social Care Act, which increased private companies’ access to NHS contracts, fragmented the NHS and removed the Secretary of State’s duty to provide a universal, comprehensive health service in England, it is the law.

If NHS England wants to change price setting and payment methods for the provision of NHS services, it should do it in accordance with the law. If changing payment mechanisms means changing the law, that is something for Parliament – and the public that puts MPs there – to decide.

Ask yourself… “what happens when government and its quangos decide they are above the law?” It doesn’t bear thinking about.

As well as being undemocratic, NHS England’s proposed changes to how NHS services are priced and paid for would undermine the NHS as a comprehensive health service for all who have a clinical need for it.

They are about enabling moves to a cut price, bargain basement NHS that uses the same business model as the USA’s limited state-funded health insurance system that provides a restricted range of health care for people who are too poor or old to pay for private health insurance.

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Even if council tax revenues increased by 4.5% a year, adult social care spending is likely to amount to half of all revenue from local taxes by 2035, the IFS has predicted.

There is “no easy way to square the circle”, the think-tank recognised in its report Adult social care funding: a local or national responsibility?, “without backtracking on reforms to local government finance and reintroducing general grant funding”.

Grant funding from government is planned to end by 2020, and councils will be expected to rely on council tax and business rates for most of their revenue.

If councils meet their social care costs through local tax revenues “the amount left over for other services – including children’s services, housing, economic development, bin collection – would fall in real terms (by 0.3% a year, on average)”, the IFS warned in the report, funded by the Health Foundation charity.

One in 10 councils are to see their share of the population aged 75 and over increase by 6 percentage points or more over the next 20 years, the IFS noted.

Potential solutions all have drawbacks, the report suggested.

These include a ring-fenced top-up grant from government but this could lead to councils cutting back on how much of their own money is allocated to these services.

If government fully funded social care, this would “remove over one-third of what councils currently spend from local control, reducing residents’ say in local spending decisions”, the report stated.

Polly Simpson, research economist at the IFS, said: “The government has to decide whether it thinks adult social care is ultimately a local responsibility, where councils can offer different levels of service, or a national responsibility with common standards across England.

“If it opts for the latter, it cannot expect a consistent service to be funded by councils’ revenues, which are increasingly linked to local capacity to generate council tax and business rates revenues.”

David Phillips, associate director at IFS, suggested the government could “decide to keep and, over time, increase the general grant funding for councils that it currently plans to abolish in 2020”.

Speaking to an audience of social care workers on Tuesday, the health secretary recognised the “economics of the publicly funded social care market are highly fragile” and said care models needed to “transform and evolve”.

He said: “We will therefore look at how the government can prime innovation in the market, develop the evidence for new models and services, and encourage new models of care provision to expand at scale.”

Hunt outlined seven key principles the government is considering as it draws up its social care green paper, due to be released before the summer.

He added: “We must make sure there is a long-term financially sustainable approach to funding the whole system.”

He added that this would “take time” but “must not be an excuse to put off necessary reforms”.

“Nor must it delay the debate we need to have with the public about where the funding for social care in the future should come from – so the green paper will jump-start that debate,” Hunt promised.

He also said he would look at making paying for social care fairer and less dependent on the “lottery of which illness” a person gets.