NHS Reform
What is "Integrated Care? |
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Why does integrated care matter? And what will it mean for patients? The King's Fund |
- Sustainability and transformation plan
- Sustainability and Transformation Plans (STPs), Keep Our NHS Public
- Accountable care organisations, accountable care systems in England, Keep Our NHS Public
- Excellent overview here, https://medconfidential.org/story/
Accountable Care Organisations
Links to researcch:
- https://keepournhspublic.com/campaigns/accountable-care/
- https://www.opendemocracy.net/ournhs/stewart-player/has-labour-really-turned-its-back-on-pro-market-nhs-solutions
- https://www.opendemocracy.net/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus
- https://twitter.com/DavidEDrew/status/983793562130223105
- https://www.kingsfund.org.uk/topics/integrated-care/sustainability-transformation-plans-explained
Accountable Care Systems
An Accountable Care System (ACS) is an integrated system of healthcare provision, and merges the funding of primary care with that for hospital care, therefore providing incentives to keep people healthy and out of hospital. NHS England defines an ACS as an area "in which commissioners and providers, in partnership with local authorities, take explicit collective responsibility for resources and population health".[1]
In each ACS area, a provider (or an alliance of providers) collaborates to meet the needs of a defined population with a budget determined by capitation. A contract specifies the outcomes and other objectives they are required to achieve within the given budget over a period of time. This may extend well beyond health and social care services to encompass public health and other services. Keeping people out of hospital by moving services into the community is a common feature. NHS trusts, Clinical Commissioning Groups and Local Authorities in the new ACSs will "take on clear collective responsibility for resources and population health".[2]
Feb.2018 | It was announced that the organisations were to be called Integrated Care Systems (ICSs), and that all 44 STPs will be expected to progress in this direction.[3] |
Sept.2017 | NHS England produced a handbook designed to support the creation of new payment models which are intended to remove the direct relationship between NHS activity and payment, improve the alignment of payment for all providers within the care model and better incentivise prevention and wellbeing.[4] |
Jun.2017 | Simon Stevens named 8 STPs as a first wave in the development of ACSs, which will receive up to £450m between them in transformation funding over the next 4 years (£14m per year each).[5] |
Sustainability and Transformation Partnerships
Jun.2017 | Criticism of STPs continued unabated. There is concern that plans are being introduced hastily without evidence that they will be effective, that money was "wasted", and changes "rushed through without appropriate evidence" – 150+ new jobs were created to run the STPs at a cost of £8.5m a year; another £1m was spent on agency staff and consultants.[6] |
May.2017 | Naylor Review: "flog off NHS assets". £325m capital funding for the strongest plans was announced, but the Naylor Review[7] said that at least £10bn would be needed to deliver proposed plans and make NHS facilities fit for purpose. The review proposed raising £6bn by selling NHS land and buildings. |
Mar.2017 | Accountable Care Systems (ACSs): New plans proposed that all STPs should evolve into #Accountable Care Systems with "clear collective responsibility for resources and population health", and some control over devolved funding for mental health, cancer and general practice. Between 6–10 STPs would be relaunched as ACOs.[8] Tens of thousands of people marched in protest in London, fearing the STPs are a "smokescreen for further cuts".[9] Hospital services could be cut in 65% of England and some hospitals will be completely closed. Jeremy Corbyn said "The NHS is in crisis; it is the fault of a govt who have made a political choice." |
Mar.2017 | Next Steps on the NHS Five Year Forward View outlined progress since 2015, and priorities for the next 2 years. A priority is to contain the growth in A&E admissions and bed days. GP practices are to be organised into "area hubs" covering populations of up to 50,000. At least 150 new inpatient beds for children and young people with mental health problems are to be provided. There will be reforms to increase the number of nurses, and to enable more flexible working. "Sustainability and Transformation Plans" are now known as Sustainability and Transformation Partnerships.[10][11] |
Feb.2017 | Care in the Community Not Cheaper. NHS England's plans to transfer patients to care in the community were criticised by the King's Fund, due to there being insufficient services outside hospitals and insufficient money to provide more. Reducing hospital beds would increase the strain on hospital services, which were overstretched during Winter 2016–2017. However, transferring services to the community is a potential improvement in many cases and plans should be considered on their merits. But further transfer to the community cannot be done without extra funding invested in community services.[12] Research by the Nuffield Trust found that some STPs were planning up to 30% reductions in some areas of hospital activity - going against trends which have persisted for the last 30 years. They conclude that out-of-hospital care may be better for patients, but is unlikely to be cheaper for the NHS in the short to medium term.[13] |
Feb.2017 | Crap Idea: A report from the National Audit Office said that plans to save £millions "may be optimistic"; that there was poor oversight; that progress had been slower and less successful than planned. Reductions in emergency admissions had not been achieved. The Better Care Fund did not achieve the planned savings of £511m; its spending of £5.3bn in 2015/16 had not delivered value for money. Also, there was "no compelling evidence" to suggest that integration would lead to savings or less use of acute hospitals.[14] |
Dec.2016 | Simon Stevens said the most advanced STPs were "capable of combining the purchaser and provider, the commissioning and provider function". In some cases he expected a "governance partnership of the relevant statutory bodies" which might become integrated organisations. But other STPs only had proposals, not yet progressed into plans. He proposed to give money and authority to the most advanced to progress their plans. NHS England would organise national support programmes, particularly for "primary care provider development" and support urgent and emergency care systems, rather than to individual organisations, and set up clinical standardisation and productivity initiatives under professors Timothy Briggs and Tim Evans.[15] |
Nov.2016 | Stevens emphasised that the Five year Forward View was about "the move to prevention and not cure".[16] |
Aug.2016 | Treasury Blackmail: Dr Brian Fisher wrote: "STPs are driven by the Treasury, and are focused on reducing NHS spend. Unless STPs meet the funding demands of the Treasury, their plans will not be approved and they will not receive any transformation money. The efficiency savings required from NHS Trusts are punishing. The STPs are being planned with almost no public or professional involvement. CCGs and Local Authorities have been told that they cannot consult or release information until NHS England has agreed the plans, and only then will they be shown to the public. Apart from the lack of transparency, the incredible figures, the probably drastic outcomes, the changes are likely to ramp up privatisation across the English NHS".[17] The King's Fund reported that the public and patients were mostly absent from plans potentially involving large scale closures, and that suggesting out-of-hospital services and GPs could take over hospital work was a "heroic assumption" since both are under too much pressure. Some councils that disagreed with the secrecy published the plans on their websites.[18] |
Jul.2016 | Anger started to surface from councils and boroughs, bitterly complaining about a total lack of transparency. NHS England responded by saying it was "accountable to parliament".[19] |
Mar.2016 | Sustainability and Transformation Plans (STPs): NHS England divided England up into 44 areas,[20] with populations between 300,000 – 3 million, each of which would implement the Five Year Forward View. The areas were locally agreed between NHS Trusts, Foundation Trusts, Local Authorities and CCGs. Each STP is required to produce a joint plan for health and health service transformation between 2016–2020, agreed with its Trusts, CCGs and Local Authorities. A leader, appointed for each STP, is responsible for the implementation of its plan.[21] |
Dec.2015 | A Sustainability and Transformation Fund (STF) of £3.8bn was announced. £1.8bn from the Fund would be provided to "help challenged hospitals to achieve financial balance while focusing on changing the way they provide high quality care for patients".[22] |
Oct.2014 | The Five Year Forward View was produced by NHS England as a planning document. It proposed the development of new models to suit local needs, and the erosion of the distinction between hospital consultants and GPs, and encouraging hospitals to employ GPs, and to permit the development of "Accountable Care Organisations" similar to those in Spain and parts of the USA. Emphasis was placed on the fact that 70% of the NHS budget is spent on the management of 15m people with long term conditions. Two new models of care – multi-specialty community providers, and primary and acute care systems – involve integrating primary care and hospital care in a single provider organisation. Stevens said that the health service would have to break out of its "narrow confines" and promote healthy lifestyles. The plan also pays far more attention to the potential for technological innovation using the internet and mobile phone and apps than any previous NHS document. The plan claimed that the NHS could deliver £22bn of annual savings in 5 years' time.[23][24][25] |
Oct.2013 | The appointment of Simon Stevens as chief executive of NHS England was announced, with effect from Apr.01.2014. |
?? | NHS Trusts ?? |
?? | Clinical Commissioning Groups (CCGs) - see notes in Talk page. |
?? | Foundation Trusts ?? |
References
- ^ What’s the difference between an ACS and an ACO? Carolyn Wickware, Healthcare Leader, Aug.10.2017.
- ^ All STPs will become 'accountable care systems', NHS England announces. Carolyn Wickware, Pulse, Mar.31.2017.
- ^ ACSs get a rebrand as NHS England seeks 'next cohort'. Sharon Brennan, Health Service Journal, Feb.02.2018.
- ^ NHS pricing: driving new care models. Monique Duffy-Brogan, National Health Executive, Oct.02.2017.
- ^ Simon Stevens names the first 'accountable care systems'. Sharon Brennan, Health Service Journal, Jun.15.2017.
- ^ A&E cuts will hit 23m people, British Medical Association says. Nick Triggle, BBC News, Jun.28.2017.
- ^ Naylor review: NHS needs £10bn increase in capital funding. James Illman, Health Service Journal, Mar.31.2017.
- ^ All STPs to become accountable care systems under latest NHS plans. Carolyn Wickware, Healthcare Leader, Mar.30.2017.
- ^ NHS protest: Tens of thousands march against 'hospital cuts'. BBC News, Mar.04.2017.
- ^ Next steps for the forward view – what you need to know. Health Service Journal, Mar.31.2017.
- ^ Next steps on the NHS Five Year Forward View. NHS England, Mar.31.2017.
- ^ Hospital cuts planned in most of England. Nick Triggle, BBC News, Feb.21.2017.
- ^ Shifting the balance of care: Great expectations. The Nuffield Trust, Mar.01.2017.
- ^ NHS vanguard plans to save £900m by 2020 ‘optimistic’, says NAO. Healthcare Leader, Feb.08.2017.
- ^ Some STPs are becoming 'integrated organisations', says Stevens. Dave West, Health Service Journal, Dec.07.2016.
- ^ House of Lords Select Committee on the Long-term Sustainability of the NHS. Long-term Sustainability of the NHS and Adult Social Care, HL 151 Report of Session 2016-17, Parliament.uk, Apr.05.2017.
- ^ NHS reform: Why sustainability and transformation plans could be dangerous. Dr Brian Fisher, GP Online, Aug.02.2016.
- ^ NHS bosses 'trying to keep cuts secret', Nick Triggle, BBC News, Nov.14.2016.
- ^ NHS reform plan 'arrogant' says Warrington council boss. BBC News, Jul.02.2016.
- ^ System change (STPs and ICSs): About the local proposals. NHS England. Accessed Apr.10.2018.
- ^ Leaders named for eight major STP patches. Work to plan the five-year transformation of NHS services in two of England’s biggest cities is to be led by local authority chief executives. Dave West, Health Service Journal, Mar.15.2016.
- ^ Sustainability and transformation plans and partnerships. "Briefing Paper No. CBP8093", Lewis Pickett, Parliament.uk, Sept.29.2017.
- ^ The NHS plan: Five things we've learned. Nick Triggle, BBC News, Oct.23.2014.
- ^ NHS five-year plan document 'packs a punch'. Hugh Pym, BBC News, Oct.23.2014.
- ^ Five Year Forward View. NHS England, Oct.2014.