A lot of purposely obscure language is used to distance the public from the realities of private control in the NHS. Here we aim to cut through the acronyms and give you some brief summaries of common references you may read in the press.



Renamed to distance it from the US ACO model

Accountable Care Organisations were originally created in the US 12 years ago, they are now being imported into the UK health service although they are not officially recognised in any Act of Parliament.

NHS England says the ICSs are simply a new way of ensuring that different types of health service bodies can work together, and integrate care to benefit patients’ health. In reality, these reforms will fundamentally change the NHS. ACOs / ICSs would gain control of billions of pounds of NHS money and restrict access to care in order to avoid overshooting their budgets. 

ACOs would be governed by company and contract law and can be given ‘full responsibility’ for NHS and adult services. They would be able to decide on the boundary of what care is free and what has to be paid for. They would have control over the allocation of NHS and taxpayers’ money while their accountability for spending it, and their obligations to the public would be under commercial contracts, not statutes.


Also known as 'Footprints'

NHS England initiated a series of Sustainability and Transformation Plans, which divided the country into 44 areas and asked healthcare providers to come up with more efficient processes. Plans which have been drafted in every area around the country lay out major changes to how services will be organised over the next decade. They attempt to find solutions to pressure on the NHS, but are controversial because their publications in many areas contain cuts to services and staffing. The Government aims to integrate services and create a new lead organisation (ICS), but this has prompted legal action from NHS campaign groups.


The worst mortgage you could ever imagine

Private Finance Initiatives are highly controversial finance schemes, introduced by John Major and expanded under Tony Blair’s government, to finance public projects while keeping costs ‘off the record sheet’. 

Rather than central Government funding infrastructure projects, such as schools and hospitals, Private Finance Initiative (PFI) means private sector banks and construction firms finance, own and operate and lease them back to the UK tax payer over a 30-35 year period. 

The UK taxpayer now owes £305 billion in PFI repayments across 700+projects. They are terrible value for money. Panorama described it as ‘paying for a hospital on your credit card’.

PFI has completely changed the relationship of the individual with the state, so that public services are no longer owned or accountable to us. 


NHS For Sale

The Act of Parliament, primarily the policies of the then Secretary of State for Health Andrew Lansley, provided the most extensive reorganization of the structure of the National Health Service since it was founded in 1948. 

Drawn up during Mr Lansley’s time in opposition from 2005 to 2010, they were outlined in a now-notorious White Paper in 2010, subheaded “Liberating the NHS”. They led to the complete overhaul of the management and bureaucratic structure of the NHS, while also placing a stronger emphasis on competition and markets in the provision of care.

Reforms were put into place to open up the NHS to private companies. These have resulted in the marketisation of the NHS with thousands of NHS contracts being put out to tender, and hundreds of contracts advertised and awarded each year. Healthcare in the UK has since become a commodity to be bought and sold much like any other product. 

This extreme action by Virgin is another example of private business riding roughshod over what should be a public service catering for our public health. When profit becomes the motive patient care and public wellbeing go out the window.

Allyson Pollock

Doctor and consultant in public health medicine and the Director of the Institute of Health and Society, Newcastle University.



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