A message from Defend Enfield NHS: "The NHS is under immediate threat and everyone who appreciates its benefits and wants them to continue needs to consider helping pay for a court case against the Health Secretary."
A message from Defend Enfield NHS: "The NHS is under immediate threat and everyone who appreciates its benefits and wants them to continue needs to consider helping pay for a court case against the Health Secretary."Exaggerated alarmist language from a bunch of amateurs? Well, it's true that the local NHS defence group can boast only one retired consultant among its members, but the court case that they are urging us to support was taken out by four leading experts on the NHS - Dr Colin Hutchinson, Professor Allyson Pollock, Professor Sue Richards and Dr Graham Winyard - who last week were joined by a scientist who is held in the highest regard - Professor Stephen Hawking, no less.
Professor Stephen Hawking: "an attack on the fundamental principles of the NHS"
"I have been lucky to receive first-rate care from the NHS. It is a national institution, cherished by me and millions of others, and which belongs to all of us. I am joining this legal action because the NHS is being taken in a direction which I oppose, as I stated in August, without proper public and parliamentary scrutiny, consultation and debate.
"I am concerned that accountable care organisations are an attack on the fundamental principles of the NHS. They have not been established by statute, and they appear to be being used for reducing public expenditure, for cutting services and for allowing private companies to receive and benefit from significant sums of public money for organising and providing services. I want the attention of the people of England to be drawn to what is happening and for those who are entrusted with responsibility for the NHS to account openly for themselves in public, and to be judged accordingly.”
Like other NHS defence groups around the country, Defend Enfield NHS (DeNHS) concentrates mainly on watching closely and challenging moves towards rationing of local NHS services. They have been monitoring work on a "sustainability and transformation plan" for the NHS in "North Central London" designed to save money so that local NHS bodies can live within the patently inadequate level of funding that the government allocates. But they have drawn some reassurance from the fact that there is currently no legal basis for this work and particularly for the expected next phase - the creation of a so-called Accountable Care Organisation (ACO) - and little prospect of enough parliamentary time being available to put in place the necessary legislation.
However, it is now known that the health secretary, Jeremy Hunt, is using a non-parliamentary technical procedure to create the legal basis for ACOs. This is what has prompted the four leading experts to set up a crowdfunding appeal to pay the legal costs of a judicial review aimed at stopping the health secretary bypassing Parliament.
The target is currently £144,000 - a large amount, but the beauty of crowdfunding is that it can be made up of small amounts contributed by many people.
DeNHS are leaving it to the experts to tell the full story - see the box below.
What are we seeking and why?
We are seeking a judicial review to stop Secretary of State for Health Jeremy Hunt and NHS England from introducing new commercial, non-NHS bodies to run health and social services without proper public consultation and without full Parliamentary scrutiny.
These non-NHS bodies would be called “Accountable Care Organisations” (ACOs). They would be governed by company and contract law and can be given “full responsibility” for NHS and adult social services.
ACOs would be able to decide on the boundary of what care is free and what has to be paid for. They will be paid more if they save money. They can include private companies (e.g. Virgin in Frimley, Circle in Nottinghamshire), including private insurance and property companies, which can make money from charging. They could also include GP practices, in which case people on their lists would automatically transfer to the ACO in order to be entitled to services. New patients would also have to register with the ACO. They will be allowed to sub-contract all “their” services.
Against the Public Interest
Such commercial ACOs would fundamentally change the NHS and many could profit from a radical reorganisation of health and social services. They would have control over the allocation of NHS and taxpayers’ money. Their accountability for spending it and their obligations to the public would be under commercial contracts, not statutes. This is not in the public interest.
It is also against the public interest that they are being introduced by stealth, without proper public consultation and without full Parliamentary scrutiny.
Just to be clear. Integration of health and care services is a desirable aim, but not whilst their funding and population bases are so different and without new primary legislation. This affects everyone in England.
Who are we?
Dr Colin Hutchinson - former Consultant Eye Surgeon in Halifax and Huddersfield and current Executive Committee member of Doctors for the NHS.
Professor Allyson Pollock - public health doctor, Professor of Public Health at Newcastle University, founding member of Keep Our NHS Public, former chair of the NHS Consultants’ Association, and co-author of the NHS Reinstatement Bill.
Professor Sue Richards - former senior civil servant in the Cabinet Office, a Director of the National School of Government and Professor of Public Management at Birmingham University, and co-chair of Keep Our NHS Public.
Dr Graham Winyard CBE - former Deputy Chief Medical Officer, Vice President of the Faculty of Public Health, and Medical Director of the NHS in England where he led the development of the National Institute for Clinical Excellence (NICE).What are the Secretary of State and NHS England doing?
The Secretary of State for Health has carried out a consultation on technical changes to regulations in order to facilitate ACOs. But he did this without providing meaningful information about ACOs themselves and without consulting the public or Parliament about what his plans entail.
The technical changes include suspending GP contracts so that they - and their patients - can transfer to the ACO. They also provide, for the first time, a definition of an “ACO” which confirms that they could be private companies.
The correspondence makes clear that the Secretary of State and NHS England intend that the first ACOs should come into being as soon as regulations are passed and before there has been public consultation.
We say that the Secretary of State and NHS England are obliged to consult and that ACOs lie outside the framework of the current legislation.
We also say that the decision to introduce them in this way is contrary to their duty of transparency in decision making in the NHS.
What are we doing?
Our lawyers have studied the replies received to our first letter before action and have sent a further letter to both the Secretary of State and NHS England.
We intend to file proceedings in the court shortly, in time to stop the introduction of any ACO.
What do we need for Round 2?
Stage 1, filing claim and permission: £24,000. This is the amount (£20,000 plus VAT) we need to cover all the work up to the point the Court takes a decision on the papers about granting or refusing permission.
Stage 2, hearings: it is impossible at this moment to know exactly what course the case will take. We need to have sufficient funds to cover the substantive hearing but also to be able to respond to all potential eventualities - such as permission being refused. For now, we estimate that an additional £120,000 (including VAT) would enable us to see the case through to a substantive hearing and judgment, and so we have a Round 2 stretch target of £144,000.
This would also help cover the risk of losing and being ordered to pay two sets of costs. Whilst we will ask the Court to cap our liability for costs, the Court cannot do so until after permission is granted.
That sounds like a lot of money.
We know that these are substantial sums. However, our estimates make pessimistic assumptions on the basis that we may have to pay costs of the other side. They also don't take account of any protection against costs that we will seek from the Court. They therefore cover the worst case scenario. But we need to plan in this way in order to be confident that we can keep the case going, and for the Secretary of State for Health and NHSE to know that as well.
This will be a big fight. We will not get the NHS back unless and until Parliament acts.
Please give what you can and support local NHS campaigners however possible.
We deeply appreciate help in publicising to friends, family and colleagues via email, social media or word of mouth.
Tweet us twitter.com/jr4nhs or contact .
Photographs by Daniel Lucas/Dpict Media.
