Reform, ration, or return to first principles: the choices of the NHS | Letters

Dr Graham Winyard questions the justification for ACOs, Sir Nick Black defends reform, Douglas Higgs calls for a debate about what is affordable and Paul Lewis says there should be a royal commission

As one of Sir Bruce Keogh’s predecessors, I have every sympathy with his desire to defend government policy, however dubious (Chief doctor denies NHS privatisation by stealth, 1 January). But solemn assurances that accountable care organisations (ACOs) are “simply about improving the quality of care the NHS offers” are a little limp, however eminent their source, given that similar claims are routinely made to justify every NHS reorganisation. Remember Patients First, which heralded the introduction of the Thatcherite reforms? As your report highlighted (Private sector dominates NHS contract awards, 30 January), there is such a yawning gap between words and deeds over the creeping privatisation of the NHS that a little study of the small print is worthwhile. Looking at the detail led me to become one of five claimants seeking judicial review of the secretary of state and NHS England’s plans.

Our legal claim is not concerned with whether ACOs are a good or bad idea. It is that such a radical and significant change cannot lawfully be introduced and implemented without public consultation, parliamentary scrutiny and legislation. This will be for the courts to decide; the case papers were filed on 11 December and we are very grateful to the more than 5,000 people who have contributed more than £160,000 to date to make this action possible. However, we also believe that the public and parliament should be very alarmed that by using commercial contracts to set up ACOs the government is exposing the NHS to major risks. If Sir Bruce really wants to reassure us, perhaps he could answer four simple questions.

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