{"id":42542,"date":"2018-07-06T15:52:17","date_gmt":"2018-07-06T14:52:17","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=42542"},"modified":"2018-07-10T15:56:56","modified_gmt":"2018-07-10T14:56:56","slug":"graham-winyard-transparency-and-honesty-in-nhs-policy-making-are-still-worth-fighting-for","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/07\/06\/graham-winyard-transparency-and-honesty-in-nhs-policy-making-are-still-worth-fighting-for\/","title":{"rendered":"Graham Winyard: Transparency and honesty in NHS policy making are still worth fighting for"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Bringing a judicial review against the government was never on my bucket list. Yet there I was in May, a happily retired former deputy chief medical officer, sitting in Court 76 of the Royal Courts of Justice watching the barrister for <\/span><span style=\"font-weight: 400\">campaign group JR4NHS<\/span><span style=\"font-weight: 400\"> engage the platoon of lawyers employed by the Secretary of State for Health and Social Care Jeremy Hunt and NHS England. <\/span><a href=\"https:\/\/www.bmj.com\/content\/362\/bmj.k3007\"><span style=\"font-weight: 400\">We were there to challenge<\/span><\/a><span style=\"font-weight: 400\"> plans to introduce Accountable Care Organisations (ACOs) in the NHS.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Former colleagues, who had known me as a bit of an apparatchik, preferring compromise to confrontation, were quietly astonished, as privately was I at times. My only post-retirement involvement in the NHS had been an all-consuming, but doomed attempt to persuade the LibDems to abandon the Lansley reforms. I watched with resignation as the mess predictably unraveled, compounded by the icy hand of austerity. Never again would I involve myself in NHS campaigning; I had done my bit for 40 years and there were many others younger and more energetic, to continue the good work.<\/span><\/p>\n<p><span style=\"font-weight: 400\">So what was it about Accountable Care Organisations that roused me to join three seasoned campaigners\u2014<\/span><span style=\"font-weight: 400\">Allyson Pollock, Colin Hutchinson, Sue Richards<\/span><span style=\"font-weight: 400\">\u2014at the judicial barricades five years later? <\/span><span style=\"font-weight: 400\">One of the reasons that the NHS enjoys huge public support is that it represents a simple concept, that people can understand. It is about much more than being \u201ctaxpayer funded and free at the point of delivery.\u201d People identify with their local hospitals and general practices and the staff who run them; there is a huge reciprocal sense of ownership and support. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The very least we should expect from government is that when it wants to make major changes to our NHS it sets out clearly what it proposes. It was the absence of this basic honesty, the obfuscation and evasion that still continues, that I felt had to be challenged.<\/span><\/p>\n<p><span style=\"font-weight: 400\">T<\/span><span style=\"font-weight: 400\">he issue of ACOs cuts to the heart of how our public services are administered<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">whether they are run as relatively simple, open, and accountable services primarily for the public good, or whether they are run in an increasingly complex commercial way, with the ability to extract profit a significant driving force, and decision-making increasingly concealed from the public and their representatives. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">When our legal action began in December last year, ACOs were the flagship in the government\u2019s <em>Five Year Forward View<\/em> for the NHS. \u00a0They were, in Simon Steven\u2019s words to the Public Accounts Committee <\/span><i><span style=\"font-weight: 400\">\u201cpretty big stuff,\u201d\u00a0<\/span><\/i><span style=\"font-weight: 400\">intended to <\/span><i><span style=\"font-weight: 400\">\u201ceffectively end the purchaser-provider split, bringing about integrated funding and delivery for a given geographical population.\u201d <\/span><\/i><span style=\"font-weight: 400\">The plan was to get 6-10 ACOs (covering more than 10% of the NHS) up and running in advance of any public consultation or Parliamentary scrutiny. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Our challenge, boosted by the involvement of Professor Stephen Hawking in the last few months of his life, alerted MPs to the potential dangers of this initiative and forced the government to accept that consultation must precede the creation of the first ACOs. The Health Select Committee examined the issue and has recommended \u201cthat ACOs, if introduced, should be NHS bodies and established in primary legislation.\u201d But through all this, the policy clarity, conceded as necessary back in January, is still absent. Why this ongoing reluctance to provide a clear detailed statement of ACO policy, not least to the High Court and the Health Select Committee?<\/span><\/p>\n<p><span style=\"font-weight: 400\">Is this because a proper<\/span><span style=\"font-weight: 400\"> consultation document would have to explain that ACOs do not have to be public sector bodies? Because ACOs are to be established by a commercial procurement process, they can be partnerships that include profit seeking private health and care providers, insurance and property companies. Manchester and Dudley, the two current frontrunner ACOs, may be NHS based, but five minutes on the internet highlights other vanguards which make great play of their private sector partnerships.<\/span><\/p>\n<p><span style=\"font-weight: 400\">However, instead of policy facts and debate, we have had a smokescreen of anecdotes about the benefits of integrated care, something no-one disputes, from senior clinicians and independent think tanks.<\/span><\/p>\n<p><span style=\"font-weight: 400\">This dishonesty at the heart of policy presentation has been shameful. The clear and present danger posed by the original ACO initiative was that it could import organisations focused on profit making into the heart of NHS decisions about who provides what, and at what cost to patients and families. This is not something to be glossed over; commercialisation has already left the NHS an ethical shadow of the original vision that commands so much public enthusiasm. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Mr Justice Green has now pronounced ACOs, in the reduced form presented to the court, as a legal option that can be consulted on. Hopefully this consultation will trigger proper debate, including on the wisdom of making the whole of a population\u2019s health and care needs the subject of 10 year commercial contracts, given our experience with the Private Finance Initiative and Carillion. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Transparency and honesty in NHS policy making still seem worth fighting for. \u00a0\u00a0\u00a0<\/span><\/p>\n<p><em><strong>Graham Winyard<\/strong> retired in May 2007 from a career in public health and medical management that included six years as medical director of the NHS in England. He is currently treasurer of Chithurst Buddhist monastery.<\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: None further declared.\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Bringing a judicial review against the government was never on my bucket list. Yet there I was in May, a happily retired former deputy chief medical officer, sitting in Court [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/07\/06\/graham-winyard-transparency-and-honesty-in-nhs-policy-making-are-still-worth-fighting-for\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38837,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-42542","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Graham Winyard: Transparency and honesty in NHS policy making are still worth fighting for - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/07\/06\/graham-winyard-transparency-and-honesty-in-nhs-policy-making-are-still-worth-fighting-for\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Graham Winyard: Transparency and honesty in NHS policy making are still worth fighting for - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Bringing a judicial review against the government was never on my bucket list. 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