Accountable Care Organisations: angels or devils?

Owl says: if you believe that Accountable Care Organisations are a good thing you will believe anything. Back-door privatisation a la USA and a ruthless way of enforcing rationing and post code lotteries rather than proper funding.

“Accountable care organisations have many strengths but should be openly debated before being implemented.

The war over the future of the NHS is being fought on multiple fronts. Campaigners, the Labour party, the government, NHS England and even Stephen Hawking are locked in combat over the structure, funding, transparency, accountability and legality of the current wave of reforms, along with the never-ending fight about privatisation – real or imagined.

The famous physicist has joined campaigners in a high court bid to block the introduction of accountable care organisations to oversee local services without primary legislation, arguing they could lead to privatisation, rationing and charging.

Meanwhile, the shadow health secretary, Jon Ashworth, has tabled a Commons early day motion after the government announced plans to amend regulations to support the operation of accountable care organisations. Ashworth argues that they are a profound change to the NHS that should be debated in parliament.

Accountable care – a term imported from the US, where it plays a key role in Obamacare – can take many forms, but it typically involves an alliance of providers with a fixed budget collaborating to manage the health needs of their local population. NHS England wants to see sustainability and transformation partnerships (STPs) evolving into accountable care systems in which integrated care supports good physical and mental health.

In June, NHS England announced that eight areas would be leading the accountable care drive. Greater Manchester is also adopting this approach, and many others are starting to use the accountable care language.

Accountable care has the potential to address many of the criticisms the most vociferous supporters of the NHS have made for many years. It goes a long way to replace competition with collaboration, and the NHS England chief executive, Simon Stevens, said it could mark the end of the infamous purchaser/provider split, which weighs down the health service with costly and often pointless bureaucracy.

Locally led, integrated systems are essential if we are going to shift the NHS from a 1970s-style hospital service to one that provides a community-based health and wellbeing service. Pooling budgets across the local area is not a ruse to disguise cuts. It is the most effective way to manage public money, irrespective of the level of funding.

The court case confuses the issue of how the NHS is organised with its funding and the role of the private sector. These are three different issues.

But the legal basis for accountable care is shaky. Faced with the wreckage left by Andrew Lansley’s infamous 2012 reforms, NHS England introduced STPs because trying to plan services through more than 200 clinical commissioning groups was never going to work.

As demand climbed, funding flatlined in the aftermath of the 2008 crash and managing long-term conditions became the dominant challenge; it was imperative to move from competition to collaboration and set a long-term goal of population health management. That is where accountable care comes in.

STPs and accountable care are operating under legislation meant for clinical commissioning groups – so collaborative systems typically serving 1.2 million people in which local government and all parts of the NHS have a say are underpinned by a legal framework for GP-managed competition overseeing populations of 250,000.

This is such a precarious legal balancing act that the 2017 Conservative manifesto promised to tidy up the legislation and regulations. But introducing an NHS bill now would be political harakiri for Theresa May, and most health service staff would prefer legal ambiguity to yet another round of organisational upheaval that would inevitably follow legislation.

So the choice is to either continue to find legal bodges to allow the NHS to collaborate and plan or – if the high court challenge succeeds – to return to the Lansley dream-turned-nightmare of full-blooded competition.

But although the thinking behind the legal challenge is muddled, that campaign and Labour’s early day motion highlight the major problem: a profound change in the management and leadership of the NHS is being introduced without informed public and parliamentary discussion.

The new approach has many strengths, but introducing it under the radar only serves to feed anxieties and misconceptions about the objective. NHS England needs to get the discussion about accountable care out in the open.”


“Remember when David Davis ran out on the first round of Brexit negotiations after less than an hour? Now we know a bit about what he was doing instead.

The Brexit Secretary had declared it was “time to get down to business” ahead of the talks – but then skipped the majority of the discussions.

He turned up in Brussels at 8am on July 17, spent 15 minutes having a “friendly chat” with EU chief negotiator Michel Barnier and another 45 minutes in a meeting with their respective officials.

After being photographed without any papers and a quick press conference, he was on the Eurostar back to London.

A Government spokesperson told the media at the time that Davis had planned to leave early but denied that the decision was connected to a vote in Parliament.

So what did he get up to upon his return to London? Something more useful than dealing with the nitty gritty of Brexit negotiations?

Transparency documents published by DExEU last night offer us an interesting insight.

They show that on July 18 – while talks were still ongoing in Brussels – Davis had dinner with Daily Mail editor Paul Dacre. …

The Brexit Secretary only reappeared in Brussels when talks finished on July 20 for a press conference which didn’t go well.

Davis was criticised by Barnier over a “lack of clarity” in the Government’s position over the divorce bill.

That’s unsurprising given the extraordinary but real possibility that he may well have spent more time speaking to Dacre than Barnier about Brexit that week.

And it might also explain why, 18 months after the referendum, he’s only just made “sufficient progress” in negotiations.

Proud of yourself, Davis?”

Buckfastleigh dissolves its planning committee – as district and county councils take no notice of its recommendations

Most districts are more likely to take the views of their local Tory association and/or Freemasons Lodges and/or developers than any of its town councils! Well done Buckfastleigh for recognising and admitting this.

“Town Council Dissolve Planning Committee

Yesterday (Wed 13th Dec 2017), at the Buckfastleigh Full Town Council meeting, The Council decided to dissolve it’s Planning Committee.

The Planning, Environment & Transport Committee, which evolved from the Planning Committee that was in place until 2015, has up till now examined and responded on every local planning application made to the Dartmoor National Park Authority (DNPA), Teignbridge District Council (TDC) or Devon County Council (DCC).

At the meeting we observed that as a Town Council we have in fact had no powers in terms of planning since 1974, when TDC took over most of the powers of the then Buckfastleigh Urban District Council, but that many local people still felt that we had some control over planning decisions. This has led to both misplaced hope that bringing a case to the Planning Committee will make a difference to their case and consequent blame when planning decisions go ahead regardless of their concerns.

It has been made quite clear in recent years that the carefully considered and well-informed responses to planning applications to DNPA, TDC and DCC have been ignored by their planning authorities in reaching decisions. In fact the Town Council has recently a formal complaint with DCC about it’s inability to enforce planning legislation and it’s misconduct in issuing planning notices in the case of Whitecleave Quarry.

Since the start of this council in May 2015, none of the responses submitted by the council in response to any major planning proposal in the parish has had an appreciable effect on the outcome. This includes the Town Council’s responses to the DNPA for piecemeal development of the Devonia site at the heart of the town which has now twice been given permission to demolish and build afresh. This despite the Buckfastleigh Neighbourhood Plan, initiated by the Town Council, which, after prolonged and detailed consultation with local residents, has recommended developing a Masterplan for the site which takes into account flood mitigation and coherent future mixed-use and also after assurances that DNPA would work ‘closely’ with us in future and that ‘mistakes’ had been made in the past.

We are quite sure too that our carefully expressed concerns about the upcoming plans for 80 plus new homes at Barn Park and Holne Rd (despite proven lack of local housing need), resulting in increased traffic/parking issues, flood risk and pressure on local amenities, will also be ignored by the DNP, who, in line with the the other authorities, seem always by default to find in favour of commercial developers whilst disregarding the needs of local residents.

We feel that by maintaining a ‘Planning’ committee, which is clearly impotent, we are misleading the public and misdirecting any concerns they have. We believe it would likely have more impact if all the individual councillors and members of the public made their own representations to planning authorities (although evidence is limited that this has any effect either!) and we don’t want to be duped into inadvertently acting as fodder for those authorities going through the motions of carrying out statutory consultative procedures, unless our opinion is actually given some weight.

We will continue to flag up any planning proposals that are likely to have a significant impact on the parish and fight for the interests of our constituents, but we will no longer formally meet as a planning committee to formulate our responses – these will come from full council. The current Planning, Environment & Transport committee will be dissolved and it’s members will meet to discuss any future remit.

Buckfastleigh Town Council”

House of Commons Council (and LEP) scrutiny report – tough new measures recommended

Recall that East Devon Alliance submitted in March 2017 a wide-ranging report on the situation in East Devon, which was considered by this committee:


that this report calls for pilot projects of strengthened scrutiny arrangements. Wouldn’t East Devon District Council AND our LEP make wonderful pilots!

”The Government must encourage a culture change at local authorities to ensure overview and scrutiny is truly independent of the executive and can properly contribute to improving services for taxpayers, the Communities and Local Government Committee concludes.

“Lack of constructive challenge

The Committee’s report on overview and scrutiny in local government, warns that scrutiny is often not held in high enough esteem, leading to a lack of constructive challenge to improve services for residents.

It recommends measures to strengthen the independence of overview and scrutiny committees and for increased scrutiny of combined authorities, Local Economic Partnerships (LEPs) and arm’s length bodies.

Scrutiny marginalised at too many local authorities

Clive Betts, Chair of the Communities and Local Government Committee, said:

“Scrutiny is marginalised at too many local authorities, which in extreme cases can contribute to severe service failures, letting down council taxpayers and those that rely on services.

Scrutiny of those in power is a vital part of any democratic system and has huge benefits for all. We are calling on the Government to strengthen guidance to make overview and scrutiny committees truly independent of those they are charged with holding to account and to make sure the process is properly funded and respected.

Only by rebalancing the system and ensuring scrutiny is held in high esteem will we see better decisions and the outcomes that residents who pay for council services deserve.”

Report recommendations

That overview and scrutiny committees should report to an authority’s Full Council meeting rather than to the executive, mirroring the relationship between Select Committees and Parliament.

That scrutiny committees and the executive must be distinct and that executive councillors should not participate in scrutiny other than as witnesses, even if external partners are being scrutinised.

That councillors working on scrutiny committees should have access to financial and performance data held by an authority, and that this access should not be restricted for reasons of commercial sensitivity.

That scrutiny committees should be supported by officers that are able to operate with independence and offer impartial advice to committees. There should be a greater parity of esteem between scrutiny and the executive, and committees should have the same access to the expertise and time of senior officers and the chief executive as their cabinet counterparts.

That members of the public and service users have a fundamental role in the scrutiny process and that their participation should be encouraged and facilitated by councils.

That overview and scrutiny committees should be given full access to all financial and performance information, and have the right to call witnesses, not just from their local authorities, but from other public bodies and private council contractors. They should be able to follow and investigate the spending of the public pound.

That the DCLG works with the Local Government Association and the Centre for Public Scrutiny to identify councils to take part in a pilot scheme where the impact of elected chairs on scrutiny’s effectiveness can be monitored and its merits considered.

Local Economic Partnerships

The Report also recommends that the scrutiny committees of combined local authorities have a role in monitoring the performance of Local Economic Partnerships (LEPs) and that the Government commits more funding to the scrutiny of mayoral combined authorities.

The inquiry was set up to examine whether the overview and scrutiny model is meeting its objectives and how decision-makers can best be held to account.

Read the report summary:

Read the report conclusions and recommendations:

Read the report: Effectiveness of local authority overview and scrutiny committees:

Full report:

Commons committee urges greater council scrutiny

A subject close to this East Devon’s heart and the cause of many sleepless days …

“A report by the Commons Communities and Local Government Committee has warned that a lack of effective scrutiny of the decisions of council leaders and elected mayors risks contributing to “severe” failures in public service provision.

The study found that funding cuts have reduced the resources and staff available to help councillors examine and challenge their activities.

The committee urges changes to Government guidance and increased funding to ensure proper oversight arrangements are in place. It also says a change of culture in local authorities is needed to prevent executives using issues of “commercial sensitivity” to hide details of deals with private companies from councillors.”

Source: Yorkshire Post, Page: 1


Theresa May today told ministers they need to be more transparent – but was herself accused of keeping the public in the dark over a cash-for-access dinner with super-rich donors.

The Prime Minister’s office has published a letter that May sent to all her Cabinet ministers about the need for government transparency. She writes:

“Online transparency is crucial to delivering value for money, to cutting waste and inefficiency, and to ensuring every pound of taxpayers’ money is spent in the best possible way…

“…The sunlight of transparency also acts in itself as an important check and balance, and helps ensure the highest standards of public life among senior government representatives.”

Very admirable. Sadly though, these principles seem go out the window when it comes to the Conservative party.

Because, in other news today, May has been accused of “hiding her links to billionaires after secretly dining with super-rich donors.”

A source has told the Daily Mirror that May attended a “lavish meal” with a host of super-rich Tory donors, which took place hours after the Government had frozen benefits.

The meal is likely to have been part of the Tory party’s Leaders’ Group, which allows the rich to buy access to the PM and Cabinet ministers for a minimum donation of £50,000.

The Tories promised to release a list of people attending these meals with ministers once every three months – but they have failed to provide any details of events that have taken place this year.

If May really wants to improve transparency in politics she only needs to walk across the hall to have a word with Patrick McLoughlin, a minister in her department who also happens to be the Chairman of the Conservative party.

Surely she wouldn’t let her party fall below the standards she’s setting her government?”

“British elections at risk from perfect storm of threats, says watchdog”

“The head of the elections watchdog has demanded urgent reform of the UK’s electoral laws and warned that the country faces a “perfect storm” of threats that could put the integrity of the system at risk.

Sir John Holmes, the chair of the Electoral Commission, also confirmed to the Guardian that the body has launched an inquiry into possible Russian interference in the EU referendum and is waiting for evidence from Facebook, Google and Twitter.

The regulator said that in order to police the electoral system properly, and hold politicians and campaigns to account, wholesale changes were necessary.

“We must avoid complacency to stop a perfect storm from forming which would put out democratic processes in peril,” he said.

In an interview with the Guardian, Holmes outlined a set of reform proposals which include:

New rules to require political campaigners to identify themselves on online advertising to combat Russian or other external interference in elections.

Increases in fines for political parties that find ways around election spending laws or fail to declare the source of their funding.

A new system requiring all voters to show photographic ID in polling stations.

A move away from only conducting votes on Thursdays and in schools or community halls. …

… “Electoral legislation is old, complicated and needs changing. There are proposals to do that. The government needs to give it legislative time,” Holmes said. …

… Following investigations into how the Conservative party moved campaigners and staff from its national headquarters to boost local party efforts in 2014 and 2015 – without properly declaring their hotel bills and expenses – the party was fined £70,000.

However, Holmes said the level of fines has to be increased to stop parties from taking such risks.

“Our ability to fine £20,000 for any single offence is not enough as an effective deterrent,” he said.

“Looking at the fines other regulators can apply, £20,000 looks fairly minimal. We think it should be bigger.”

Holmes also said the government should consider extending the use of photo identification at polling stations.

This suggestion follows allegations of widespread voting fraud, particularly around Asian communities in Birmingham, Bradford and east London.

The commission recommended in 2014 that voters should be required to prove their identities before casting a ballot, in the wake of widespread voter fraud in Tower Hamlets.

Critics of the plan say it potentially disenfranchises large numbers of people on low incomes who do not have photo ID.

Voting laws should also be reformed to allow new ways of voting, Holmes added.

“We should look at changes for a new generation of millennials who are the digital generation.

“We are not saying that we should move now to online voting because of the risks of hacking but that doesn’t mean that nothing ought to change.

“We need to ask ourselves whether voting on a Thursday in an old school building is the only way we can do this.”

The commission will release a report on Wednesday into the performance of returning officers at this year’s general election, with Holmes set to outline his proposalsin a speech to the Institute for Government later in the day.”