SECRET plans to create a super health trust and transform the way services in Oxfordshire are run can now be revealed. 

A leaked letter seen by the Oxford Mail outlines the intentions of three health organisations in the county to create what they call an ‘Accountable Care Organisation’.

But doctors, health watchdogs and MPs say they have been kept in the dark about the proposal, which has been kept under wraps until now.

Based on an American model as yet untested in the UK, the not-for-profit ‘supertrust’ would be responsible for all health services in the county and replace the existing set-up, formed just four years ago.

Services including A&E and elective hospital care, maternity, fertility, rehabilitation, GP practices and community and mental health care could all be affected by the move.

What is an ACO?

Accountable Care Organisations (ACOs) are integrated systems growing in popularity in the United States in response to growing cost and service pressures.

They bring together several providers under one 'umbrella' that takes responsibility for the cost and quality of care for a defined population.

So far no ACOs exist in the UK but the first one is set to emerge in Northumbria in 2017, incorporating both health and social care.

In Oxfordshire the trusts and OxFed proposed that from 2017/18 all CCG-commissioned services provided by OUH would be managed by the joint venture, as well as Oxford Health's physical health services for older people and early visiting, local improvement schemes and prescribing incentives for GP practices.

It would also manage the CCG's contribution for Oxfordshire County Council's 'pooled budget' for health.

The NHS trusts involved have remained tight-lipped about the plans, saying they are in the very ‘early stages’. But the letter reveals the deadline for agreeing to the process was yesterday, and the deadline for signing off the contract with the Oxfordshire Clinical Commissioning Group (CCG) – which currently holds the purse strings – is December 23. 

The plan, which would dramatically change how health services are run, is set to be in place by the end of the current financial year in  March. 

But there has been no public consultation and many leading figures, doctors and MPs among them, have not been informed of the intention. 

Oxford GP Helen Salisbury said she was told by GP federation OxFed in the summer that the plan was being considered, but ‘had no idea it had got to this stage’.

She said: “I am flabbergasted. This is big and has been entirely hidden from public view. None of us have had a chance to examine what it means for patients or doctors.

“It’s possible that it may be an advantage to us all. But the people who are doing this - to whom are they accountable?”

Andrew Smith, the MP for Oxford East, said: “It’s stunning to see this popping up out of the blue.

“It’s called an ‘Accountable Care Organisation’, but its accountability has not got off to a good start, as it’s not clear how it will be accountable to the public. 

“Coordination and integration of these services might well make sense but, especially with all the legitimate fears about cuts and privatisation, those planning change in vital NHS and community services need to take the public with them in explaining how it would work and how patients would benefit.”

Intentions by Oxford University Hospitals NHS Foundation Trust, Oxford Health NHS Foundation Trust and OxFed to create the new organisation were revealed in a ‘letter of intent’ to the CCG, dated September 28 and obtained by the Health Service Journal.

Over the summer OUH and Oxford Health failed to agree a way of integrating care, which led to the CCG threatening to obtain services on the open market.

In 2016/17 the CCG’s projected spend on all health services in the county – including acute care, ambulance services, primary care, mental health and learning disability services – was £138.2m. 

The CCG is currently still working on plans for Oxfordshire forming part of an overall ‘Sustainability and Transformation Plan’ for Berkshire West, Oxfordshire and Buckinghamshire, which was leaked in the Oxford Mail last week and is likely to see dramatic changes to the way the NHS works in the county.

Signatories said they were ‘delighted’ to present the plans, which would begin with a ‘temporary, three way collaborative joint venture’ in 2017/18.

Retired GP Dr Ken Williamson, chairman of the county’s Keep Our NHS Public group, said: “It has been a secret process, effectively.

“They’re refusing to say who is going to run the ACO, the implication being that it might be a huge further slice of privatisation in Oxfordshire.

“It all sounds a bit desperate. Even now we don’t have enough information to be clear what they’re going to do and they have to sign off the contracts by December 23.”

Jacquie Pearce-Gervis, of watchdog Patient Voice, said: “It’s really rushed through. It’s an imaginative idea but why hasn’t it been discussed in public?”

Quizzed by the Oxford Mail at a meeting this week, CCG chairman Joe McManners said there was ‘something in’ the idea but it was ‘unlikely’ to come into effect in 2017.

He added: “It feels like it is not going to be a short-term solution. But the detail really needs to be looked at.”

So far there are no ACOs in the UK. In America they function as integrated healthcare systems, set up as a response to growing financial and service pressures.

Rosalind Pearce, chief executive of Healthwatch Oxfordshire, said she was ‘not surprised’ at the revelation as there was a need for a more ‘joined-up approach’ to health.

But she added: “What’s important is that if it starts to have an impact we would want to hear about that, and be able to take a view on it.”

HOW IT COULD WORK

Accountable Care Organisations (ACOs) are integrated systems growing in popularity in the United States in response to growing cost and service pressures.

They bring together several providers under one 'umbrella' that takes responsibility for the cost and quality of care for a defined population.

So far no ACOs exist in the UK but the first one is set to emerge in Northumbria in 2017, incorporating both health and social care.

In Oxfordshire the trusts and OxFed proposed that from 2017/18 all CCG-commissioned services provided by OUH would be managed by the joint venture, as well as Oxford Health's physical health services for older people and early visiting, local improvement schemes and prescribing incentives for GP practices.

It would also manage the CCG's contribution for Oxfordshire County Council's 'pooled budget' for health.

The letter states the long-term key principles of the ACO would be being a not-for-profit venture based on 'clinically led decision making', with 'the ability to manage the system's financial and clinical risk'.

A working group has been set up by the providers to work on developing proposals.

WHAT DON'T WE KNOW?

The Oxford Mail put the following questions to OUH, Oxford Health, OxFed and Oxfordshire CCG this week:

  • Why have OUH, Oxford Health and OxFed suggested this model for the county?
  • What does it mean for the public?
  • Is it a permanent change if agreed on?
  • How would it work in terms of funding? How much money would it save? 
  • Has Oxfordshire County Council seen the proposals? Who has been informed?
  • Who came up with the initial idea? 
  • What meetings have been had, if any, with the CCG and Oxfordshire County Council?
  • What effect would it have on the way care is delivered and the patient experience?
  • What are the benefits of an Accountable Care Organisation?
  • How likely are you to reach an agreement on contracts for 2017/18?
  • Is there going to be a public consultation? Why were people not informed of this before?
  • The letter states that it’s a ‘jointly agreed initial proposal’, has it been agreed by all parties including the CCG? 

In a joint statement, all four bodies said: "People in Oxfordshire should be able to have consistently good joined-up health care across providers wherever they receive it and regardless of how the NHS is organised. At the same time healthcare in Oxfordshire and nationally faces challenges around rising demand. 

"More people are thankfully living longer and increasingly more people of all ages have multiple, long-term health and care needs. 

"More people now need care across different settings – hospitals, GPs/primary care, clinics, nursing homes and home care agencies.

"We remain at an early stage in our discussions about developing more joined up NHS care across Oxfordshire - there is no plan to launch a new Accountable Care Organisation (ACO) at the end of March. What we are committed to doing is finding ways for local NHS providers to work together more closely across the county.

"In the longer term we are looking at a number of ways this might be achieved, of which an ACO is just one."