The must read stories and debate in the NHS

Stranger things

The never-ending fight against the US-style healthcare bogeyman has become an order of magnitude weirder this week. A campaign group, named 999 Call for the NHS, has launched a judicial review against NHS England over its contract for accountable care organisations.

The core of their argument appears to be that the Health and Social Care Act 2012, which specifies that an NHS service must be paid for in line with the NHS tariff, will be breached should commissioners use NHS England’s new ACO contract to award a fixed price population contract to a provider.

Essentially they argue that the Health Act is breached by a fixed price ACO contract as it does not pay for actual use of services. It’s hard to know what the campaigners – or a judge for that matter – would make of the integrated(ish) prime provider deals that have already been awarded across the country, which already bundle tariff applicable services into a larger, less transactional contract focused on prevention.

In an interesting turn of events the very thing anti-privatisers protested against in the past – the section of the Health Act designed to facilitate competition within the NHS, which was the subject of endless controversy at the time – has now become the weapon of choice in the battle to save the NHS.

We seem to remember being warned in 2011 of a US-style healthcare system being Lansley’s ultimate goal.

Leaving aside the beyond-satire elements of all this, there are very few NHS commissioners that actually look close to awarding an ACO contract. Earlier this week HSJ found a couple of areas in Manchester that had come up against a number of roadblocks in their journeys toward ACO creation.

Would the case have been different had the PM’s general election plan worked? Perhaps. It would certainly have made it easier for the government to push through the new legislation needed to put ACOs in place.

Although they seem convinced that saving the NHS from integrated population health provision will leave us all better off, the campaigners have not spelt out how thwarting ACOs will better match what we get with what we can afford to pay for.

Still, they may be providing a public service by stress-testing the Lansley legislation and exposing the non-existent governance arrangements around STPs.

Slow fixes

The NHS headed into the weekend with a chastening day on Friday, with reports criticising the service’s response to the cyberattack in May and flagging up serious problems in children’s mental health services.

The National Audit Office’s investigation into the unprecedented WannaCry cyberattack revealed more than 130 urgent cancer referrals were cancelled and more than 1,200 medical devices were infected because of the ransomware virus.

Much of its criticism was aimed at the Department of Health and NHS England for not testing plans for a major cyberattack – despite warnings a year earlier that an attack was likely.

“As the NHS had not rehearsed for a national cyberattack it was not immediately clear who should lead the response and there were problems with communications,” the report said.

The next national chief clinical information officer will need to help address this “absence of timely central direction” before another cyberattack can hit the NHS.

There was uncomfortable reading in the CQC’s review of children and young people’s mental health services too.

The regulator found patients struggling to access mental health services, a fragmented landscape of provision and the risk of children being placed in an inpatient unit miles from home.

Paul Lelliott, the CQC’s lead inspector for mental health, said he couldn’t propose any “quick fixes” but better access to intensive support at home and round-the-clock crisis services could help keep young people out of inpatient units.