The must read stories and debate from Friday

ACO no-go

Accountable care organisations only seriously entered the NHS consciousness after the Five Year Forward View was published in 2014. Since then they have gone from being the Next Big Thing, to the sound nobody wants to listen to.

The public opposition to ACOs was perhaps predictable, considering the associations with American style healthcare, so it is no big surprise that national leaders are having to deal with a backlash

What NHS England perhaps didn’t expect was rejection from NHS providers, commissioners and now private providers.

After a series of complications with the national ACO contract, the four areas with advanced plans to procure a single contract to create an accountable care type organisation began to drop off.

It started with Northumberland, followed by Manchester and Dudley. This week the last member to leave the group is Sunderland CCG. Last year, the commissioner waxed lyrical about plans to procure a single MCP contract, worth £340m, by this April.

One year on, Sunderland has abandoned its plans in place of a softer, alliance contract approach.

Even private providers have made it clear they don’t want in. David Hare, chief executive of the NHS Providers Network, wrote on hsj.co.uk that independent sector providers are not expecting to take on responsibility for running any ACOs in the near future.

Mr Hare said there are “genuine concerns over the risks to which any operator taking on a large scale ACO contract would be exposed”.

Although there is yet to be any real involvement from the private sector in ACOs, their public surrender will nevertheless be welcome news to anti-privatisation campaigners.

One community trust chief executive suggested on Twitter that given the current climate, their conceding is not entirely surprising.

The future of ACOs in the NHS is looking less healthy by the day and with only Dudley CCG holding out hope of a revival, ACOs could become the NHS’s one (or no?) hit wonder.

Date for the subsidiary

As HSJ reported last month, a growing number of NHS trusts are creating subsidiary companies tasked with performing a range of non-clinical functions.

But it’s not just trusts that are at it.

The Department of Health and Social Care itself has established a wholly owned subsidiary, which will be the vehicle for managing the changes to the way the NHS buys common goods and equipment.

One noteworthy feature of this process is the amount (£4m) spent by the DHSC on EY consultants who are helping to set up the 200-staff company. That amount will keep rising.

However, if the company, known as the “intelligent client coordinator” helps deliver anywhere near the £2.4bn savings targeted, these upfront costs will be justified. Possibly.

But remember: it is not the ICC that will be striking the cost efficient deals with suppliers – that responsibility sits with the firms newly appointed to run the “category towers”.

One contentious aspect that has emerged in the debate over trusts’ use of subsidiaries is the notion that new staff will not be hired on NHS terms.

HSJ understands new staff joining the ICC in future will be hired on Agenda for Change. Failure to do this would not have reflected well on DHSC, and may have discouraged applicants hoping to join from trusts or other parts of the public sector.

The ICC is set to start trading at the start of the new financial year.