15:27, April 23 207 0 theguardian.com

2018-04-23 15:27:04
NHS England faces first legal challenge to core of shake-up plans

NHS England faces a legal challenge to its blueprint to overhaul how the service operates, which critics say the plans are unlawful and could lead to patients being denied treatment.

Campaigners will on Tuesday try to derail moves plans to introduce of (ACOs) which they say could force doctors to decide what care a patient needs based on how much money is available rather than how sick someone is.

If the changes go through then individual hospital trusts and clinical commissioning groups (CCGs) will no longer each receive an annual budget of their own. Instead NHS bosses would give a joint budget to pay for healthcare in whole areas of England to an ACO which would be made up of all the acute, mental health and providers of other forms of NHS care locally.

A judicial review has been secured by the campaign group 999 Call for the NHS. The group says the new contracts for the first wave of ACOs are unlawful under the Health and Social Care Act 2012 and could threaten patient safety by forcing hospitals and doctors to ration patients’ access to treatment.

The case, which will be heard by the high court sitting in Leeds, is the first of two judicial reviews which judges have granted to explore the legality of ACOs. The other, which has been brought by a group including the late cosmologist Prof Stephen Hawking, will be heard in London on 23 and 24 May.

Joanne Land, of 999 Call for the NHS, said: “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 healthcare for people who are too poor or too old to pay for private health insurance.”

Rowan Smith of Leigh Day, the lawyer firm representing the campaign group, said the fixed pooled budgets of ACOS would end the system of “payment by results”, under which hospitals are paid for episodes, and lead to a “race to the bottom” in prices charged for care, which would hit patients.

Asked about the judicial review, an NHS England spokesperson said: “This is a mistaken effort which would frustrate the move to more integrated care between hospitals, mental health and community services. The effect would be to fragment care and drive apart the very people who are now rightly trying to work more closely together on behalf of the patients they jointly serve.”

Simon Stevens, its chief executive, said last month: “Our view is that it is possible to fund primary care, health and hospital services in a combined way, in a way that is consistent with the statutory legal framework. If the courts say it is lawful, that clears the issue up once and for all, and if the courts say it isn’t, that’s obviously not an approach we will be doing.”

The NHS is also facing a number of other legal actions that seek to block planned changes to local health services. Campaigners fighting Dorset CCG’s plans to move A&E and maternity services from Poole hospital to Bournemouth have secured a judicial review, which will take place on 17 and 18 July.

Corby CCG in Lincolnshire is also facing a lawsuit over its plans to downgrade the town’s urgent care centre. Instead of patients being able to walk in and been seen within four hours, in future they would undergo a telephone triage with someone with no medical qualifications and then given an appointment – but the four-hour A&E target would no longer apply.

Campaigners called Hands Off Lydney and Dike Hospitals are also taking legal action to try and halt Gloucestershire CCG’s plans to shut two community hospitals and replace them with one, and cut the number of beds available from 47 to 24.

Jonathan Ashworth, the shadow health secretary, said: “There is considerable concern and suspicion that because of both the Lansley reforms and Tory underfunding, so called Accountable Care Organisations will lead to privatisation and cuts to local NHS services.

“There remain many unanswered questions about how an ACO will be accountable to the public, what the levels of private sector involvement will be, and what the implications will be for NHS staff.

“There ought to be a full debate and vote in parliament before any changes are introduced.”

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