Show caption Prof Sir Bruce Keogh, NHS England’s medical director. Photograph: Joe Giddens/PA NHS NHS shake-up is not a Trojan horse for privatisation, says top doctor Prof Sir Bruce Keogh says introduction of accountable care organisations is about improving quality of care Denis Campbell Health policy editor Mon 1 Jan 2018 06.00 GMT Share on Facebook

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The NHS’s top doctor has denied that radical plans to reshape the way patients are cared for are a “Trojan horse” for wholesale privatisation of the health service.

Prof Sir Bruce Keogh, NHS England’s national medical director, says setting up new bodies called accountable care organisations (ACOs) in eight areas of England is simply about improving the quality of care the NHS offers.

Critics fear that the introduction of ACOs – based on US healthcare bodies of the same name – could lead to swaths of the NHS falling into the hands of private healthcare firms and other profit-driven companies. These are thought likely to be keen to influence or control how ACOs’ pooled budgets – potentially billions of pounds each – are spent.

“Rather than the Trojan horse for privatisation that some critics may fear, this is a bold attempt to unite a fractured system and stop people being pushed from pillar to post,” Keogh writes in a comment piece for the Guardian about the NHS as it approaches its 70th birthday on 5 July 2018.



Last week it was revealed that private firms won £3.1bn worth of contracts in 2016-17 to provide NHS services, and that Richard Branson’s Virgin Care scooped £1bn – the largest amount any for-profit firm has secured in a year.

Keogh says ACOs will be “complete care systems”, with NHS physical, mental, community-based and ambulance trusts working in close partnership along with local council providers of adult social care in order to give patients a more joined-up service that caters for all their needs together.



“This year NHS bodies in eight places will come together with local councils and other organisations to work as complete care systems, with the needs of patients, not individual organisations, driving decision-making,” he writes.

But Ben White, a junior doctor and NHS campaigner who is supporting one of two ongoing lawsuits challenging the legality of ACOs, said: “If they are not opening the door to greater private sector involvement, why would the Department of Health say membership of an ACO is up to the ACO itself? Keogh simply cannot know whether these 10- to 15-year contracts involving commercial organisations will lead to the same rip-off as private finance initiatives.



“Therefore, scrutiny and consultation is critically important and should be uncontroversial. [Previously] Keogh notably spoke about the importance of acting in the public interest over surgeons’ mortality rates, so he should support this.”

In his article, Keogh says the NHS, because it is socially equitable and based on need rather than ability to pay, is a more important British invention than many others that have changed science and healthcare, even ahead of penicillin, vaccination and the structure of DNA.



“In 1948, at the NHS’s founding, there were no routine antibiotics, anti-cancer drugs or blood pressure treatments, and infectious diseases were common. This has all changed, thanks in part to British science which has brought the world vaccination, penicillin, the structure of DNA, IVF and stem cell transplants, artificial hips and MRI scanners,” writes Keogh.

“But our greatest innovation is the NHS itself. At 70 years old and with resources stretched, some question the funding model and suggest the NHS is not fit for the future; nothing could be further from the truth.”