You start your article by acknowledging current NHS severe financial constraints. reviewing plans from areas developing integrated care systems, conducting interviews with leaders and other local stakeholders from these areas to explore how plans are being developed and implemented in practice. The principles of a universal and comprehensive NHS funded through taxation and available on the basis of need and not ability to pay will not be affected. Clinical commissioning groups (CCGs) are either merging or agreeing to collaborate and are working closely with local authorities in many areas to develop joint or integrated commissioning. Ham reassures us that private companies have neither the intention nor the capacity to pursue contracts in this non-NHS brave new world. © The King's Fund 2018 Integrated care systems The journey so far Alex Baylis, Acting Director of Policy The King’s Fund April 29th 2019 Changes in legislation will be needed to align current developments with the statutory framework. establish clear mechanisms by which residents can exercise patient choice over where they are treated. The PACS in Northumberland is developing in a similar way. Two points I would want to emphasise are, firstly the lack of clear data or use of data within STPs. The update on the Forward View announced that some STPs would evolve into accountable care systems (ACSs) and these have since been rebranded as integrated care systems. On this. We describe developments in the new care models and integrated care systems and ask whether they are resulting in cuts in services and the privatisation of services. It will lead to fragmentation. The trust collaborates closely with the mental health trust and work is under way to engage general practices in integrating care. Little wonder then that there is concern. 3. The King's Fund, February 2014. This is not surprising when deficits are endemic among NHS organisations following several years of austerity. Our updated long read looks at work under way in these systems and at NHS England’s proposals for an accountable care organisation contract. What’s happening in integrated care systems? And there is evidence that there is more public appetite for this there has been in my lifetime. Also as with what happened with Richard Branson, threatening to sue the NHS if he didn't get a lucrative contract and the Department of Health conceding to his demands, surely this will lead to others i.e. A Healthier Wales: Our Plan for Health and Social Care sets out the Welsh Governments long term future vision of a ‘whole system approach to health and social care,’ which is focussed on health and wellbeing, and on preventing illness. This report is based on interviews with eight of the ‘first wave’ ICSs to understand how they are developing and to identify lessons for local systems … The King's Fund and The National Lottery Community Fund ... Covid-19 is the biggest challenge the health and care system has faced in living memory; it's essential that lessons are learned from this experience. Find out more about each STP. Anna Charles, Senior Policy Adviser to the CEO, The King’s Fund Read Annas' reports and blogs. Our recent work and content on this topic is listed below. £15.00 Thinking differently about commissioning. Our health and care needs are changing, with more people living longer often with multiple long term conditions. ICPs formed under the new care models programme are invariably led by NHS organisations, often in collaboration with partners in local government and the third sector. They bring together NHS providers and commissioners and local authorities to work in partnership in improving health and care in their area. As they develop, it is expected that they will: The quid pro quo for ICSs offered in the Forward View update was: The first 10 ICS areas were selected on the basis of the quality of their STPs and an assessment of their ability to work at scale to demonstrate progress in taking forward the ambitions of the Forward View. Commissioners and providers will be expected to demonstrate that their plans to use the contract are robust before they can proceed. You have to have explicit, informed individual consent with the whole rationale and proposed use of the data explained to each sharer even under the current Data Protection legislation but the General Data Protection regs coming in in May 2018 are much stronger, and the penalties on data controllers (like GPs) and data processors are phenomenal. Private providers may be brought in by NHS organisations where they have distinctive expertise to offer, for example in providing analytical support, but this has occurred throughout the history of the NHS and is not the result of the developments discussed in this paper. These systems have no statutory basis and rest on the willingness of NHS organisations to work together to plan how to improve health and care. This will involve a new social contract between the NHS, Local Authorities, and communities, and a revived sense of civic purpose. These teams manage the care of individuals who have been identified as being at high risk of hospital admission. An advanced example of a PACS can be found in Salford, part of the Greater Manchester devolution programme, where health and care services are working in partnership to meet the needs of a population of 230,000. Greater Manchester stands out because its work on health and social care is embedded within a broadly based and long-established public sector partnership led by local authorities. Sustainability and transformation plans, or partnerships as they are now called, build on the work of the new care models and set out ambitions to integrate care and transform services. This fact of life does not deter them however from trying again and often winning again. under local leaders may be the way to ensure local people are involved in decision making, and also in delivery of improvements. So perhaps it is naive to express surprise, as you have, that these issues have not been propely aired in public. Anna Charles, Chris Ham, Don Berwick, Claire Fuller. For example, Blackpool and Fylde Coast (population 300,000) and Berkshire West (population 530,000) are working to integrate health and care provision in a way that closely resembles what is happening in ICPs. Our aim is to use the next several years to make the biggest national move to integrated care of any major western country. Thus the financial heart of these contracts will driven by models of accounting which do originate in US healthcare thinking. This will enable them to support organisations that are in deficit by drawing on surpluses from organisations that are performing well, provided that the system as a whole achieves financial balance. Six areas in England have been chosen to join the first phase of a major grant-funding and development programme designed to improve the health and wellbeing of communities and tackle health inequalities. The risk this creates is the possibility of legal challenges from private companies who feel that commissioners are not using competitive procurement as required under the law and instead are keeping contracts within ‘the NHS family’. Who provides the extra funding when your population ill-health excedes the local budget??? This report is based on interviews with eight of the ‘first wave’ ICSs to understand how they are developing and to identify lessons for local systems and national policy-makers. It has been clear for some time that simply working our current hospital-based model of care harder to meet rising demand is not the answer. I look forward to hearing. Integrated care systems represent a fundamental and far-reaching change in how the NHS works across different services and with external partners. However, US ACOs and English ICSs are vastly different in scale (on average, US ACOs provide services to c. 19,000 enrolled patients) and operate in radically different political, financial and cultural contexts. These capabilities do not exist among private providers currently working with the NHS as they deliver specific services rather than comprehensive care. The reality is that the NHS is being sliced and diced into readily contracted out portions with inadequate specifications, controls, and safeguards. Response to NHS England and NHS Improvement on proposed changes to integrated care systems, Read our written submission to NHS England and NHS Improvement on the proposed changes to integrated care systems, New NHS Digital data on the state of the NHS estate reveals the backlog maintenance cost has increased. Does it work? Integration is a false god that should not be worshipped. These developments have been made possible in part because Greater Manchester was able to access its share of the national Sustainability and Transformation Fund to pump prime improvements in care and this has helped enable the area to make faster progress. The language of accountable care originated in the United States at the time of President Obama’s health care reforms, and its use in the NHS has raised concerns that it could result in health and care services coming under the control of private companies. The biggest risk to integrated care is organisational protectionism, rather than privatisation, linked to a history of competitive behaviours and sometimes poor relationships between the leaders who need to collaborate to make a reality of integrated care. £15.00 Leading for integrated care. One of these questions the legality of ACOs under the Health and Social Care Act 2012 while the other claims that ACOs will lead to increased privatisation. Trust and The King’s Fund, examines some of these new models and their potential for delivering better outcomes at lower cost. Latest publications from The King's Fund. Place based care, with GP at scale at its centre is surely to be encouraged. Our own work has found that progress is more rapid where effort has been invested in building trust and collaborative relationships. The central aim of ICSs is to integrate care across different organisations and settings, joining up hospital and community-based services, physical and mental health, and health and social care. As examples, Greater Manchester, with a population of 2.7 million, has ten ‘local care organisations’ (to use its own terminology). How are integrated care systems and partnerships developing? To begin with, only a few areas have expressed an interest in using the contract; others are using existing legislative flexibilities to develop integrated care. Their principal functions are planning for the future, building on the work that went into STPs; aligning commissioning behind their plans; incorporating the regulatory functions of NHS England and NHS Improvement; managing performance in their areas; and providing leadership across the system covered by the ICS. learning for local and national leaders and share examples of good practice. To go against this leads to the threat of legal action (see Virgin Care). Social care and independent and third sector providers may also be involved. The King's Fund believes that the developments discussed in this paper should be supported because they offer the best hope for the NHS and its partners to provide the health and care services required to meet the needs of the growing and ageing population. Linked to this, the risk that the behaviour of regulators will undermine moves to system working if they resort to top-down performance management to address performance challenges rather than relying on ICSs to take the lead in so doing. These contacts when they come will be predicated on fixed (and, according to current political leaders, immutable) budgets. OK, no need for consent for direct medical purposes with clinical team members in most cases but social care? And it means fully engaging the public in changing lifestyles and behaviours that contribute to ill health and acting on the recommendations of the Marmot report and other reviews to improve population health. The partners. Shifting the centre of gravity SCIE’s Logic Model for Integrated Care Published by: LGA. This means tackling risk factors such as obesity and redoubling efforts to reduce health inequalities. agree a performance contract with NHS England and NHS Improvement to deliver faster improvements in care and shared performance goals, manage funding for a defined population by taking responsibility for a system ‘control total’, create effective collective decision-making and governance structures aligned with accountabilities of constituent bodies, demonstrate how provider organisations would operate on a horizontally integrated basis, for example, through hospitals working as a clinical network, demonstrate how provider organisations would simultaneously operate as a vertically integrated system linking hospitals with GP and community services, deploy rigorous and validated population health management capabilities to improve prevention, manage avoidable demand and reduce unwarranted variations. Constraints on NHS funding over the past seven years, combined with rising demand from a growing and ageing population, have put the NHS under enormous pressure. Integrated care and partnership working reading list, Boost for local health partnerships as six areas secure place on £3 million grant-funding programme, The King's Fund and The National Lottery Community Fund (TNLCF) have joined forces to support genuine partnership-working in. Chris Ham draws on the. Integrated care happens when NHS organisations work together to meet the needs of their local population. £15.00 Home care in England: views from commissioners and providers. An advanced example of an MCP is Encompass in east Kent where 13 general practices are collaborating to improve care for a population of 170,000. Responsibility for service delivery rests with the organisations that provide care within ICSs and many of these organisations are collaborating to put in place ICPs. The NHS Long Term Plan set out the aim that every part of England will be covered by an integrated care system by 2021, replacing STPs but building on their good work to date. The project involves three main components: Subscribe for a weekly round-up of our latest news and content, By Anna Charles et al - 20 September 2018, By Professor Sir Chris Ham - 20 February 2018. And local authorities the abolition of the consequences of these new models include equity. Better meet the needs of their local population do not exist among private providers currently working the! And improve population health of local communities the centre of gravity SCIE ’ s Fund the... Been the policy of Governments since 2010 and very much remains in place to better meet needs! Between ICSs and ICPs is much less clear in smaller ICSs Frimley health illustrates some of our content. Of general practices, community services, and just ploughing on is not especially.. 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