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We should all be concerned that Jeremy Hunt is proposing amendments to legislation in order to facilitate Accountable Care Organisation (ACO) contracts before there has been any public consultation on these new structures. The main driver appears to be an expectation that ACO will reduce health care costs, although considerable experience from the USA suggests this will not be the case. There are in fact many objections to ACO (1) which, through replacing multiple procurements by a single, major long term contract to provide health and social care services for an entire area, increase the scope for potential NHS privatisation. Indeed, the draft model contract for an ACO published by NHS England seems designed to appeal to multinational corporations.
ACO will also help strip NHS assets such as land and buildings; enforce the unprecedented real terms freeze in spending and transfer the NHS funding shortfall to new local, self contained areas; provide incentives for rationing of services and denial of care; rely unrealistic assumptions about collaboration and sharing of risk and gain between private and NHS service providers; through ‘transforming’ the NHS workforce be likely to have a detrimental effect on pay and conditions. It may well be that the integration of health and social care to be brought about by ACO is simply a cloak to disguise the involvement of private companies.