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It’s time to call out Integrated Care

The Tories’ so-called Integrated Care plan is the Trojan horse for the Americanisation of the NHS — it even used to have the same name as the US system. So why is almost nobody talking about it, asks CLAUDIA WEBBE MP

IN the already inadequate parliamentary debate about the perilous state of our NHS, the discussion will rightly touch on the numbers of nurses, on the closure of wards and hospitals, ambulance waits, patients on trolleys in Accident and Emergency, waiting lists, cancer care and cancelled operations.

It will also sometimes – not often enough – include the intolerable burdens Tory cuts and policies are placing on NHS staff and the resulting risks to patients.

But it will never, or almost never, involve discussion of the government’s Integrated Care plan, even though it underpins and cements the harm done to the NHS by decades of neoliberal policies – and will lead to more and more patients not receiving the care they should.

But what is Integrated Care – and how have the Tories managed to take things so far with so little attention?

In part, this has been a branding exercise. When the national roll-out first began here, there was some reaction from campaigners because it was called Accountable Care, delivered by Accountable Care Organisations or ACOs, the same term that the US currently uses for the system over there.

When the planned new system was described in 1971, to then-president Richard Nixon, who made it law in the US, Nixon was told infamously that: “All the incentives are toward less medical care, because the less care they [the health companies] give them, the more money they make.”

This was a purposeful move to a smaller role in healthcare for the state, intentionally creating a vacuum for private healthcare to fill – or not to fill if that meant it could make even greater profits.

For the past 30 years, by degrees and with little debate and with varying levels of stealth, the same system has been rolled out in Britain. Now, with very little variation, it forms the basis for the health plans and policies of the government and, some would argue, of opposition benches in the House of Commons too.

Because of the association Accountable Care had with the US, the use of the same name for the plan here generated a reaction. But the plan never went away – it was simply renamed Integrated Care, while politicians and tame commentators stepped up a narrative, to justify it, that it was really to solve the lack of links between the NHS and social care.

How does Integrated Care work, then? Fundamentally, it’s simplicity itself: a group of healthcare providers are incentivised to cut costs by allowing them to keep a percentage of whatever sums they manage to avoid spending from their pooled healthcare budget.

Inevitably, this means rationing and withholding care, as well as cutting costs and corners. In conjunction with national shrinkage targets, the result has been fewer services, fewer beds, fewer treatments, and fewer Accident and Emergency departments.

Since 2021, Tim Ferris of Massachusetts General Physicians Organisation has been NHS England’s National Director of Transformation, responsible for applying this scheme.

Previously, he'd been invited to Britain to explain how it works: “If we can keep our spending below [set costs] then we will share in some of the savings, and that’s the basis for the accountable care organisation contracts.”

This is not an anomalous or aberrant view. NHS England’s Strategy Unit makes clear, in a report produced in 2018 by their NHS Midlands and Lancashire Commissioning Support Unit, that the principle of “cash for cuts” is central to an Integrated Care System’s purpose:

“Risk and reward sharing is a key feature of the policy agenda for Accountable Care Organisations in the US and Integrated Care Systems in England.

“It is a simple and attractive concept, offering a commissioner the opportunity to co-opt and incentivise a provider to moderate growth in healthcare demand by sharing in the savings or cost over-runs.”

Clearly, the advocates of these cuts in Parliament do not want to announce that they are introducing a plan to reward companies and NHS trusts for withholding treatment. As Margaret Thatcher’s Cabinet noted in the 1980s, to be honest about their intentions for the NHS would be political suicide for a government.

Instead, in Parliament we’ve been told this was about “integrating” services, to ensure that proper debate about the real policy — which has always been to close down facilities and downgrade services — is avoided.

In his 2007 film Sicko, Michael Moore warned us how rewarding such reductions in state care had ballooned the US private healthcare industry: “Patients were given less and less care […] while health insurance companies became wealthy.”

Far from being just an absence of resources, it is this policy direction copied from the US that is overwhelmingly at the core of the situation in which we find ourselves today.

We are seeing this worked out all over England. In my own constituency of Leicester East, Leicester General Hospital faces drastic reductions in services as part of what is called Better Care Together (BCT) – but in the small print, the NHS admits that the BCT plan is in fact part of the government’s push to so-called Integrated Care.

This is being presented to my constituents and the rest of Leicester as part of an improvement plan – but in fact, hospitals are being hollowed out and providers are being incentivised to reduce services and spending, to make even greater profits.

This model has led to hugely inflated health spending in the US while at the same time making health less accessible and increasing postcode lotteries – and it is doing the same in England.

Nationally mandated reductions in services are conceived and designed to bar and discourage patients from accessing services, running the NHS on minimal capacity — like a business instead of like a public service, always aiming for the maximum profit for the minimum outlay, which in healthcare means less treatment.

Readers may be surprised that directly copying the wildly expensive and grossly unequal US health system has happened in Britain with barely a ripple.

But they will have heard endlessly, in the media and in the Commons, the Trojan horse that has been used to sell the policy to MPs and the public: as a necessary change, based on supposedly changing social needs specific to Britain, without mentioning where it’s really from or what it’s for.

Those looking to benefit from this system — and their heavily funded agents in Parliament — have carefully framed the causes of the current crisis to support the supposed need for a shift away from the accessible, local care the NHS was based on, towards cherry-picked services “closer to home.”

But in this framing, closer to home means losing general hospitals in favour of smaller, more limited services that can be run for profit. Politicians and commentators blame older people, the pandemic, and “demand” — but say nothing about the pattern of service closures and downgrades that has created a breeding ground for private profit at the expense of straining what is left of the NHS to its limit and beyond.

All this is happening right under our noses, all across England — yet the subterfuge is succeeding, and the vast majority of the public is unaware of it, while many pro-NHS campaigns ignore it or have even fallen for it.

All those who oppose the destruction of our NHS must work relentlessly to counter this shameless deceit and raise public awareness, so that justified outrage leads to public action.

Claudia Webbe is MP for Leicester East — follow her on Twitter @ClaudiaWebbe.

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