The promise of integrated care will only be delivered if doctors, nurses, allied health professionals, pharmacists and many others in clinical roles work much more with each other and with staff working in social care and the third sector around the patients and populations they serve. NHS England - This framework is for local health and care systems, organisations, communities and patients, wishing to develop and implement new ways of working. 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 … ". PACS and MCPs take different forms in different places but share a focus on places and populations rather than organisations. £15.00 Clicks and mortar: Technology and the NHS estate. It will take some convincing to persuade people that establishing comprehensive contracts for monopoly provision of healthcare over 10-15 years and contemplating handing these to the private sector is a wise policy. 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 means tackling risk factors such as obesity and redoubling efforts to reduce health inequalities. The NHS and its partners must act on learning from these examples, otherwise services will remain fragmented even if organisations become more integrated. There is no prospect of this happening in the short term because the government lacks a working majority and because Brexit is dominating the parliamentary timetable. Appropriate then, that a review of data security in the NHS should be launched at this year’s King’s Fund Digital Health and Care Congress in London on 5 and 6 July. a few questions from an old lawyer: 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. NHS organisations working individually or in partnership are much better placed to take on the contract, and national NHS bodies are reported to be exploring how a new form of NHS organisation might be used for this purpose. What does it mean for the NHS? 10.30am Evidence of the impact of new care models . Reversal of fragmentation and further integration are dependent primarily upon repealing the H&SC Act. To avoid a repetition of these difficulties, NHS England and NHS Improvement have put in place the Integrated Support and Assurance Process to provide guidance to commissioners and providers on the development of complex and novel contracts. The experience of Hinchingbrooke Hospital in Cambridgeshire, where the private company, Circle, had to hand back its contract to provide NHS services because of insufficient funding suggests that there are limited opportunities to generate profits from NHS contracts. It would also be wrong to see ICSs and ICPs as a means of privatising services. It is a truism that the urgent tends to drive out the important and it would be understandable if the development of integrated care were delayed as a consequence. The other thing that needs to be developed with communities is Outcomes measures that have been developed by local people and are measured by them too - again the role of community researchers at Bromley by bow looks terrific. 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. 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. As discussed earlier, commissioners wishing to make use of the ACO contract will have to go through the Integrated Support and Assurance Process and demonstrate that their plans are robust. Commissioning will become more strategic and concerned with the funding and planning of new models of integrated care rather than the annual contract round that has added little value to the NHS in recent years. Key organisational and management barriers Bringing together primary medical services and community health providers around the needs of … The Fund’s work suggests that there is considerable misunderstanding about what is actually happening in the NHS and many of the concerns that exist are misplaced. Siva Anandaciva outlines the impact of the estate on patient care, and highlights four key issues for consideration. What does it mean for the NHS? Integrated care systems (ICSs) bring together local providers, commissioners and local authorities to improve population health and wellbeing. The growing and ageing population is a longer term issue, in no way causative of today's unprecedented NHS crisis. So how can the system build on this learning to bring about positive change and renewal? For staff, improved collaboration can help to make it easier to work with colleagues from other organisations. Integrated Care - What is it? A selected list of references held by The King's Fund library. What does the future hold for integrated care systems? 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’. The Frimley Health and Care system is one of the case studies used in the latest King's Fund report on integrated care systems Key Message from the report: The development of integrated care systems (ICSs) represents a fundamental and far-reaching change in how the NHS works, both between different parts of the service and with external partners. Some new care models have reported absolute reductions in emergency admissions per capita. 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. Little wonder then that there is concern. The areas mentioned here all face the same challenges as the rest of the NHS in responding to rising demand with constrained budgets, but they indicate how new ways of working are beginning to deliver improvements in care. Shifting the centre of gravity SCIE’s Logic Model for Integrated Care Published by: LGA. But rather than treating it like some unfortunate objective phenomenon (like bad weather) as you seem to do, why do you not mention that underinvestment in the NHS is a deliberate political policy. 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. The need to avoid creating another tier of management by incorporating the work of NHS England and NHS Improvement into ICSs and aligning and streamlining commissioning behind ICSs and ICPs, as is beginning to happen in some areas. While existing flexibilities have been helpful in enabling progress to be made in many areas, they will be severely tested by continuing financial pressures. (even as "small" a component part as the odd GP going back to his/her GMS contract)? Anna Charles, Chris Ham, Don Berwick, Claire Fuller. 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. learning for local and national leaders and share examples of good practice. NHS England has outlined ambitions for sustainability and transformation partnerships (STPs) to evolve into ICSs. The most ambitious forms of integrated care aim to improve population health by tackling the causes of illness and the wider determinants of health. Partnership working is not easy in the context of the Health and Social Care Act 2012 which was designed primarily to promote competition, but some areas are finding ways of overcoming the obstacles and are improving health and care for their populations. The experience of Frimley Health illustrates some of the service changes that have contributed to these trends. once again, so how should new capital funding be prioritised? Fund’s work to clarify what is happening. These capabilities do not exist among private providers currently working with the NHS as they deliver specific services rather than comprehensive care. Siva Anandaciva outlines the impact of the estate on patient care, and highlights four key issues for consideration. Through our series of events, you'll gain expert guidance and practical insights from those leading the way to help you prepare for the transition. This is the raison d'etre of integrated care and why it should be supported. Supporting integration: workforce considerations (King's Fund 2018) Supporting integration through new roles and working across boundaries (King's Fund 2016) The principles of workforce integration (Skills for Care et al. 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. Current indications are that only Dudley and the city of Manchester are planning to use the ACO contract when it becomes available. First - the money. Examples include improved access to GP services, investment in mental health services, and major changes to acute and specialised hospital service. ICOs therefore are not a way to obviate this crisis in the short or medium term. Added to which the 'accountable' bit in the original AC description does not mean democratic accountability. the building of local “place-based” care and support systems; system leadership for integration. The need to engage a wide range of stakeholders, patients and citizens in the work that is under way, to listen to their concerns about the ACO contract and other issues, and to involve them in developing new care models and integrated care in a transparent process. The King's Fund, February 2014. Prof Ham states that ICS won't save money, which is problematic for the 44 STP areas obligated to save £22bn. Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England, NHS England has recently changed the name of accountable care systems to integrated care systems. 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. It requires organizations and individuals to act against their own interests and against the law in pursuit of a faith that integration will lead to the promised land. This is particularly important for the growing numbers of people with several medical conditions who receive care and support from a variety of health and social care staff. Integration as described in this article is not new: health & social care, 1ary & 2ary care, community working, all exist already with both benefits and hindrances to care and efficiency. Integrated care is not a panacea and unless implemented with skill it will not deliver the improvements in health and care envisaged in the Forward View. Integrated care systems have allowed organisations to work together and coordinate services more closely, to make real, practical improvements to people’s lives. An ACO would take responsibility for the health and care of a defined population by managing a budget under a contract with commissioners awarded after competitive procurement. the ability for the local commissioners in the ICS to have delegated decision rights in respect of commissioning of primary care and specialised services, a devolved transformation package from 2018, potentially bundling together funding for the, a single ‘one-stop shop’ regulatory relationship with NHS England and NHS Improvement in the form of streamlined oversight arrangements. More publications about Adult social care. Several areas of England have been working to put in place the new care models outlined in the Forward View, and every part of the country has developed sustainability and transformation plans (STPs) describing how they will implement the Forward View locally. Mental health has been a particular priority and service users have worked with providers to improve access to a wider range of support. ICPs and ICSs could be derailed if any of the partners decide to withdraw, even when national NHS bodies are making it clear that they see this way of working as being the future for the NHS. Our updated long. Does it work? This short animation aims to bring integrated care to life for anyone involved in improving patient care. What are ACOs and why are they controversial? Integrated care happens when NHS organisations work together to meet the needs of their local population. read looks at work underway and makes sense of all the terminology. In PACS, hospitals often take the lead in joining up acute services with GP, community, mental health and social care services. But if that is the intention what is all the talk of accountable care organizations, draft contracts, legal manoeuvres to escape transparency and scrutiny in detailed planning, and huge bills from management consultancies all about? For the foreseeable future, the NHS and its partners will have to find ways of making progress through workarounds, hoping that the political will can be found before too long to bring the law into line with the priority being given to integrated care. There is growing interest in developing integrated care systems (ICSs) as a way to integrate care and improve population health. This content relates to the following topics: NHS England has recently changed the name of accountable care systems to integrated care systems, which describes more accurately the work being done in the 10 areas of England operating in this way. They will also have the opportunity to demonstrate what the Forward View is seeking to achieve through organisations working in partnership rather than competing. Another world might just be possible............... Quotations I take umbrage at Integrated care Integrated care aims to improve patient experience, achieve higher levels of efficiency and extract value from health delivery systems The aim of integrated care is to address fragmentation in patient services, and enable more coordinated and continuous care. ICSs are an attempt to give local leaders more control over the use of the collective resources at their disposal, thereby enabling them to back the ambitions set out in STPs with flexibility to move money around. These teams manage the care of individuals who have been identified as being at high risk of hospital admission. Our aim is to use the next several years to make the biggest national move to integrated care of any major western country. These should be spread at scale and pace, for the sake of our health and social care and everyone in need of it. £15.00 A vision for population health: Towards a healthier future. Many of us see that 'it doesn't have to be like this', and our number is growing. Or will it – under the day-to-day challenges of managing the money, staff and backlog – simply turn out to be the spirit of the Blitz, evaporating as 2021 progresses and the immediate pressures of Covid subside? ", "Rather than opening up the NHS to increased privatisation and competition, as some have claimed, these developments are likely to have the opposite effect. The partners. The evidence of increased efficiencies, both clinical and financial, are beginning to emerge. ICPs are very much a work in progress and even the most advanced examples have much work to do to realise the potential benefits. This project aims to bring together information on how integrated care systems are developing in England; to identify. Who is paying for that individual advice and negotiation for anyone signing up and taking the risks? Updated NHS planning guidance published in February 2018 states that other areas will become integrated care systems where they can demonstrate strong leadership, a track record of delivery, strong financial management, a coherent and defined population, and compelling plans to integrate care. Jenny Sims reports back on the key topics under discussion at this year’s King’s Fund Digital Health and Care Congress . 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 contacts when they come will be predicated on fixed (and, according to current political leaders, immutable) budgets. 5yfv new models include private equity and private providers, so it's unclear what end is being envisaged here. The distinction between PACS and MCPs is being blurred as different care models evolve and increasingly converge. The contract could also be used to commission services from ICPs developed through the PACS programme if commissioners and providers decide that a single contract would be preferable to using different contracts to integrate care. Rather, the NHS needs to work differently by providing more care in people’s homes and the community and breaking down barriers between services. £15.00 Leading for integrated care. 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. This legislation is still very much in force. Commissioners will have a key role in holding providers to account for delivering outcomes agreed in contracts. But what is happening in the areas developing ICSs, and what can others learn from their experiences? The other big risk is the ability of experienced leaders to find the time to develop new ways of working while also tackling the huge operational pressures facing the NHS and social care. Some forms of integrated care involve local authorities and the third sector in working towards these objectives alongside NHS organisations. NHS England needs to do much more to explain what the ACO contract would add to existing ways of integrating care and indeed whether it is needed at all at this stage in the development of integrated care. Given that the aim, as you explain, of the ACS/ACO trajectory is to bring different elements of Health and Care together, to get different organisations (including within the voluntary sector) working together around longer and more person-centred care and treatment pathways which snake out into the community, is this likely to happen? ICSs are coming together at a time when improvements in life expectancy are … If the intention is to effectively recreate District Health Authorities, then let's just do that. local areas between the voluntary and community sector, the NHS and local authorities to improve the health and wellbeing of local communities. 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. "Trust" and "collaboration" just won't hack it; long gone are the days of "My word is my bond". What are integrated care and population health? The distinction between ICSs and ICPs is much less clear in smaller ICSs. This paper describes the current system of commissioning and funding general practice in England, and its shortfalls. Third - Integration. In February 2018 The King's Fund posted this item on integrated care systems. Place based care, with GP at scale at its centre is surely to be encouraged. Will these developments lead to privatisation? Another reason why private companies are unlikely to be favoured is that the ACO contract will require bidders to have the capabilities to deliver a wide range of NHS and related services. How about it , Chris? (2) Only a few areas expressed an interest using this contract, Question which organisations led you to this conclusion, was the hand picked CCGs selected and controlled by the Department of Health expressed an interest, or was it decided democratically by NHS medical staff and NHS users with no interference from the D.O.E. Developments in integrated care in England take different forms in different places. 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. Our health and care needs are changing, with more people living longer often with multiple long term conditions. The need to clarify the likely end state of current developments to provide greater certainty about the direction of travel for local leaders who are working to develop integrated care for their populations. This content relates to the following topics: The final report was published in summer 2018. £15.00 Thinking differently about commissioning. Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England. Download. The alternative is to use existing contracts underpinned by agreements among providers to work in partnership as is happening in the new care models and ICPs. 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. 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. Trust and The King’s Fund, examines some of these new models and their potential for delivering better outcomes at lower cost. Thus the financial heart of these contracts will driven by models of accounting which do originate in US healthcare thinking. Our report examines the approach being taken by some clinical commissioning groups (CCGs) and local systems where traditional notions of commissioning are no longer guiding their way of working. Pondering for a time I have transposed this to Hodges' model below figure 1. It is what I have worked towards. 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. Love Mike Hope's idea of developing a new social contract - Think this is one that Chris Ham and colleagues could develop the thinking on- considering the role of Leadership and governance for integration. It will lead to fragmentation. STPs were seen by critics as a way of NHS organisations working together to agree how they would live within the financial envelope available to them. 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. Subscribe for a weekly round-up of our latest news and content, By Professor Sir Chris Ham - 7 February 2018. View More » £15.00 Thinking differently about commissioning. Their work also underlines the need for additional funding for the NHS as well as the need for new ways of working to sustain and transform health and care. Integrated care and population health should not be expected to save money but have the potential to enable resources to be used more effectively. Systemic barriers to integrated care must be addressed if integrated care is to become a reality. This virtual conference shared learning from existing Integrated care systems (ICS) before the deadline to have every part of England covered by an ICS, as set out in the NHS long-term plan. The King's Fund, August 2017 This briefing from The Kings Fund explores the development and implementation of an Accountable Care System (ACS) in Canterbury, New Zealand. 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. Chris Ham draws on the. Accountable care organizations in the USA add 15% to the costs of healthcare. Secondly, the report rightly points out the need to engage with clinicians, patients, citizens and local stakeholders, but the report should have gone further and outlined the duty of CCGs to engage. And focus on the short term not the long term. Integrated care systems represent a fundamental and far-reaching change in how the NHS works across different services and. Identifiable in our case in NW London, as we have just found out. 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’. The largest ICSs include within their boundaries several ICPs that are very similar to those that have emerged under the new care models programme. The NHS also needs to give greater priority to the prevention of ill health by working with local authorities and other agencies to tackle the wider determinants of health and wellbeing. And there is evidence that there is more public appetite for this there has been in my lifetime. page we pull together some of our core content and recent commentary to help make sense of the developments in integrated care. It will not. I would say here that as someone who has spent his last 20 years focusing on the lifelong rehab needs of a much under-diagnosed and under-considered group of people (those with various acquired brain injuries), there is nothing I would welcome more than genuine integration of services. "by population-based budgets. In law. The very logic of the market, which still holds sway, and of the behaviour of the aforementioned private corporations if they become contract holders, will mitigate against integration. 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