Does NHS outsourcing really need a 999 call?

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NHS England recently won a judicial review brought by campaign group ‘999 Call for the NHS’ which challenged the lawfulness of the payment mechanism in the Accountable Care Organisation contract. The case centred on the Whole Population Annual Payment element of the contract, which would see an ACO being paid based upon the number of patients in its area rather than being “demand led”.

Put simply, ACOs bring together an area’s NHS services under one contract with a single organisation, either as a single entity or an alliance of smaller providers. They have evolved from the Sustainability and Transformation Plans (STPs) which were first announced in NHS planning guidance in December 2015 and have been developed to try to deal with a combination of funding constraints and rising demand from a growing and ageing population.

A second judicial review was heard on 23 and 24 May, this time brought by the ‘JR4NHS’ group which included the late Professor Stephen Hawking. This group aims to “save our NHS from an American-style takeover” as a result of privatisation, with the chart below showing how private sector spend by NHS organisations has been steadily increasing over the last five years:

NHS Private Sector Spend

However, Health Secretary Jeremy Hunt said in a recent House of Commons debate that NHS privatisation simply “is not happening” and, if we forget about the outsourcing of non-medical services such as IT systems and facilities management etc and focus on the ones people really tend to care about, the figures may offer some reassurance.

In fact, Porge’s Illuminator* data shows that only around 6% of expenditure on acute/clinical services in 2016/17 went to the private sector, with spend up to the end of February 2018 showing this level being maintained during 2017/18.

Mr Hunt has previously pointed out that “using a charity like WhizzKids to supply wheelchairs to disabled children or using Specsavers to speed up the supply of glasses is not privatisation”, whilst an update from JR4NHS following the hearing stated that Jenni Richards QC (for the claimants) “made clear that the case raises fundamental questions about the future of the NHS” and that Mr Justice Green had reserved judgement until a later date.

*Illuminator is Porge’s Public Sector spend insight tool, which amalgamates and categorises the “transparency” spreadsheets produced by over 1000 public sector bodies. So if you need to know what’s really happening in the public sector, talk to us about our fact based Public Sector Market Insight Services.

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