ACO’s and the need for popular Decision-Making Power:

The Fight Against Accountable Care Organisations
Shows the Need for Decision-Making Power


Laura Pidcock speaking at a House of Commons meeting against the introduction of ACOs on January 23

The High Court on January 26 granted permission to Professor Stephen Hawking, Dr Colin Hutchinson, Professor Allyson Pollock, Professor Sue Richards and Dr Graham Winyard to bring a judicial review against the Secretary of State for Health and Social Care, Jeremy Hunt, and NHS England to challenge the introduction of Accountable Care Organisations (ACOs) into the NHS. The legal challenge is against the plan of the government, Department of Health and NHS England to allow private companies to take direct control of the NHS. The money to fight the case was raised by a crowd justice fund, which has so far raised £180,000 at the time of writing.

The organisers of the case point out that the government and NHS England “are resisting every inch of the way and have already run up over £90,000 that they have claimed from us. On the basis of their estimated costs we have been advised that we face a potential liability of £350,000-£450,000 if we lose. Plus maybe VAT. If we can’t limit our potential liability, then the case is over. We would have to withdraw.” The Secretary of State and NHS England have also refused their suggestion that each side bear its own costs whatever the outcome of this important case. “We have therefore asked the court to hear our application for cost capping at a short hearing and have revised the application to ask that the amount we would have to pay, should we lose, be capped at £160,000.” In the meantime the organisers have launched a third crowd justice fund, which has presently raised more than £50,000.

At the same time, as a result of the pressure from the resistance of the people to the privatisation of the NHS, NHS England suddenly announced on January 25 that it will be launching a twelve-week “consultation” on the contracting arrangements for ACOs. Having fragmented the NHS into competing commissioners and providers, both “public trusts” and “private companies”, they are now claiming that ACOs will allow health and care organisations to formally contract to provide services for a local population in a “co-ordinated way”.

The statement makes apparent that it is in response to the legal challenge with the claim that an ACO is “not a new type of legal entity and so would not affect the commissioning structure of the NHS”. NHS England then goes on to claim that the two areas at the forefront of using an ACO contract of this sort are Dudley and Manchester’s proposed local care organisation. “Emerging bidders for both proposals are NHS bodies, have the support of local GPs and are not private sector organisations.”

However, what NHS England is hiding is not whether Dudley and Manchester will be run by “public” or “private” companies, but that the whole direction reveals the sheer scale of involving the private health companies with “public” Trusts in running the NHS, where the destruction of public authority is replaced by precarious arrangements directly dominated by private finance with its narrow self-serving aims and the interests of cartels and oligopolies.

The people are right to fight and resist the government and NHS England, who are trying to impose ACOs in running the NHS without any legislation being passed in Parliament. It is a key move in the government’s aim to replace the rule of public authority by the diktat of finance capital, insurance monopolies and the like over health services. But fighting for the alternative is not a question of restoration of the old public authority, which has now been abandoned by the ruling elite and in which the people had no real role to play. What this fight against ACOs puts on the agenda is who decides and the need for the power to enforce the ownership of the people and guarantee their rights, which are absent at present. It is the decision-making power of the working people that is required.

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