Those of us who desperately want sustainable integrated services and person-centred planning, rather than box ticking, should actually look to a refounding of the NHS, reaffirming its original principles in terms of the right care at the right time for everyone, at no cost to themselves, and with a particular emphasis on social justice. Prof Ham states that ICS won't save money, which is problematic for the 44 STP areas obligated to save £22bn. 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. 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. Principia, a partnership of 12 practices that is part of the Nottingham and Nottinghamshire ICS, is also breaking down barriers between hospitals and primary care by moving some specialist services into general practice and by GPs and community nurses reaching into the hospital. NHS England - This framework is for local health and care systems, organisations, communities and patients, wishing to develop and implement new ways of working. 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. First - the money. The aim of this work is to bring together information on how ICSs are developing in England; identify learning for local and national leaders; share examples of good practice; and highlight issues that need to be resolved to support their development. 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. The emphasis in MCPs is on GPs working at scale to forge closer links with community, mental health and social care services. Will the drive toward integration, system-working at place and in integrated care systems be sustained? Integrated care systems | The King's Fund Who provides the extra funding when your population ill-health excedes the local budget??? Providers and commissioners are working together to establish ICPs and ICSs and some of the alliances of providers that make up ICPs are carrying out commissioning functions as subcontracting arrangements are put in place between lead providers and their partners. Successful integrated care systems will take more control of funding and performance with less involvement by national bodies and regulators. Pondering for a time I have transposed this to Hodges' model below figure 1. The King's Fund, February 2014. 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. Subscribe for a weekly round-up of our latest news and content, By Professor Sir Chris Ham - 7 February 2018. As we know, many of the usual suspects who bid for contracts are past masters at winning bids for themselves, (against in-house NHS and voluntary sector competition) when they must know full well that they cannot deliver in the longer term. Mental health has been a particular priority and service users have worked with providers to improve access to a wider range of support. It is what I have worked towards. In February 2018 The King's Fund posted this item on integrated care systems. Understanding how integrated care systems are supporting people to stay well. Our health and care needs are changing, with more people living longer often with multiple long term conditions. Anna Charles, Chris Ham, Don Berwick, Claire Fuller. Our updated long read looks at work under way in these systems and at NHS England’s proposals for an accountable care organisation contract. Other areas that were considering its use have become more cautious because of the way the contract has become associated with privatisation. a few questions from an old lawyer: Read the report: A year of integrated care systems: reviewing the journey so far. Other examples include progress in the Dorset ICS in making better use of acute hospitals through the designation of hot and cold sites in Bournemouth and Poole; work to moderate use of hospitals through closer collaboration between care homes, GPs and other services in the community, developed through new care models vanguards; and work in the Principia MCP in the Rushcliffe area of Nottingham where GP practices serving a population of 125,000 are collaborating to increase investment in primary care, support people to die in their home or preferred place of care, and reduce strokes. Our updated long. ". 1 Evidence for your "long read" - what is the "Fund's work" ( as in the sentence:" 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.")? Changes in legislation will be needed to align current developments with the statutory framework. 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. Building on these developments, NHS England’s update on the Forward View, published in March 2017, made the following bold statement. It would be similar to an ICP except that a single organisation would be awarded the contract and it would be a means of formalising the partnership agreements on which new care models and ICPs have developed to date. This legislation is still very much in force. Integrated care and population health should not be expected to save money but have the potential to enable resources to be used more effectively. The partners. 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. But absolutely no further reorganisation should take place until the funding, staffing and beds crises have been resolved. The MCP has five community hubs bringing together multidisciplinary teams of GPs, community nurses, social care workers, mental health professionals, pharmacists, health and social care co-ordinators and others. And there is evidence that there is more public appetite for this there has been in my lifetime. The importance of engaging fully with local authorities and other partners and avoiding an NHS view of the world taking precedence. It looks at some of the key determinants that have made the system a success, explores how it has overcome challenges and examines what steps can be taken in the UK to emulate the success of the Canterbury system. ICSs are at a much earlier stage in their development with Greater Manchester being the most developed. Integrated care systems | The King's Fund The most ambitious forms of integrated care aim to improve population health by tackling the causes of illness and the wider determinants of health. 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. Hear the latest updates on how ICSs are developing in England and the learning for local and national leaders. Shifting the centre of gravity SCIE’s Logic Model for Integrated Care Published by: LGA. The distinction between ICSs and ICPs is much less clear in smaller ICSs. And focus on the short term not the long term. Both are examples of what we describe as ICPs and they have emerged without the need for competitive procurement. Using more private health will decimate the NHS budget which will satisfy those involved with this New NHS Model and those who want to de-nationalise . We also discuss what needs to be done to build on progress to date. the building of local “place-based” care and support systems; system leadership for integration. ", "Rather than opening up the NHS to increased privatisation and competition, as some have claimed, these developments are likely to have the opposite effect. 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. Only the abolition of the Act and its terms will make them cease. 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. Thus whatever the local preferences might be, and after much initial legwork by NHS and sometimes Social Care organisations , there will be nothing to stop these characters gaining ACO contracts in the longer term. They bring together NHS providers and commissioners and local authorities to work in partnership in improving health and care in their area. The NHS and its partners must act on learning from these examples, otherwise services will remain fragmented even if organisations become more integrated. The paper draws on three years’ development work with leaders in health care systems in north-west England, undertaken by the Advancing Quality Alliance (AQuA) and The King’s Fund which has adopted a ‘discovery’ approach to developing integrated care and the leadership capabilities supporting it. Latest publications from The King's Fund. The reality is that the NHS is being sliced and diced into readily contracted out portions with inadequate specifications, controls, and safeguards. This will involve a new social contract between the NHS, Local Authorities, and communities, and a revived sense of civic purpose. Section dealing with-: WILL THESE DEVELOPMENTS LEAD TO PRIVATISATION NHS services being managed by private companies (1)Will this lead to the American Health Care industry (Which is favoured through KPMG involvement which were invited by the Tory hierarchy to instruct them in the so called new NHS model). 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. A variety of terms are used to describe these developments and this can be confusing and potentially misleading. 3. 2014) Think integration, think workforce: three steps to workforce integration (CFWI 2013) More guidance from Social Care Online. As yet we have not seen any political will to do this. Chris Ham - you can do better than this! Eight areas of England have been identified to lead their development. 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. Integrated care partnerships (ICPs) are alliances of NHS providers that work together to deliver care by agreeing to collaborate rather than compete. 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? Systemic barriers to integrated care must be addressed if integrated care is to become a reality. This aim is being pursued through the new care models, STPs and the evolution of some STPs into integrated care systems. The need to ensure that national regulators change their ways of working (rapidly) to support developments in the NHS. Furthermore, UK Health services are almost certainly on the table for impending UK-US trade deals. Guidance from national bodies reinforced this perception with the requirement that plans should show how they would bridge the financial gap facing the NHS. The jargon of 'integrated care' is much-used in health policy and management circles. 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 King's Fund 2018 Integrated care systems The journey so far Alex Baylis, Acting Director of Policy The King’s Fund April 29th 2019 Integrated care systems (ICSs) have evolved from STPs and take the lead in planning and commissioning care for their populations and providing system leadership. This is obviously true. Two points I would want to emphasise are, firstly the lack of clear data or use of data within STPs. COVID-19 Adult safeguarding insight project: findings and discussion. One version of the contract would allow core funding for general practices to be included in the budgets controlled by ACOs, though many GPs would be reluctant to put their own income at risk in this way. 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. Commissioners and providers will be expected to demonstrate that their plans to use the contract are robust before they can proceed. Data collected by NHS England, for example, shows that PACS and MCPs in aggregate have seen lower growth in per capita emergency admissions to hospitals than the rest of England. This fact of life does not deter them however from trying again and often winning again. Siva Anandaciva outlines the impact of the estate on patient care, and highlights four key issues for consideration. However, it won't happen like this. 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. 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. 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. These contacts when they come will be predicated on fixed (and, according to current political leaders, immutable) budgets. As stated, these developments are works in progress, so much detail is yet to emerge. In law. The challenges in making progress are real and should not be underestimated. 10.30am Evidence of the impact of new care models . 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? They will not deliver results quickly which is why national and local leaders need to make a long-term commitment to developing integrated care as the main way of providing and funding care in the future. By all means, experiment along these lines but it would be nice to see the results, evidence it works and does not just add another costly administrative tier on top of the NHS before being sold off the back of the lorry. Both are focusing on integrating care and working to improve population health in their areas. Local care organisations across the conurbation are also building much closer links between NHS organisations and local authorities. The distinction between PACS and MCPs is being blurred as different care models evolve and increasingly converge. For the purposes of this briefing, the following definitions describe the three main forms of integrated care that we have observed in our work. Hospitals have changed their ways of working in A&E to see and treat patients rather than always admitting them to a bed. The cumulative impact of many service changes lies behind Frimley Health’s success in moderating hospital use. 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. 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. 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. Key organisational and management barriers Bringing together primary medical services and community health providers around the needs of … 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. Second - the 2012 NHS and Social Care Act. Some forms of integrated care involve local authorities and the third sector in working towards these objectives alongside NHS organisations. 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. Forty-four areas of England prepared these place-based plans during 2016 as NHS England and other national bodies emphasised the need for providers and commissioners to collaborate in addressing the challenges they face. The difficulty this creates is that workarounds are unstable, even in the most favourable circumstances. One of the consequences of these developments is that the commissioner/provider split that has underpinned health policy since the early 1990s is unravelling. The aim of this briefing is to explain what is happening in practice drawing on our work with the NHS and local government. 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. ICPs are at various stages of development across England and ICSs have been established in ten areas1, two of which – Greater Manchester and Surrey Heartlands – are part of the government’s devolution programme. Many of us see that 'it doesn't have to be like this', and our number is growing. 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. In order that change is effectively undertaken all levels of government and other public funded organisations need to demonstrate good management, Independent management accreditation is required to achieve this. The PACS in Northumberland is developing in a similar way. "Trust" and "collaboration" just won't hack it; long gone are the days of "My word is my bond". These providers include hospitals, community services, mental health services and GPs. £15.00 Leading for integrated care. These should be spread at scale and pace, for the sake of our health and social care and everyone in need of it. 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. £15.00 A vision for population health: Towards a healthier future. . So explain how these rebranded systems are going to work legally, please with lawful data sharing? 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. 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. ICSs are coming together at a time when improvements in life expectancy are … These teams manage the care of individuals who have been identified as being at high risk of hospital admission. 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. 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. This project aims to bring together information on how integrated care systems are developing in England; to identify. And there is evidence that there is more public appetite for this there has been in my lifetime. And what will it mean for patients? The evidence of increased efficiencies, both clinical and financial, are beginning to emerge. ", And how can anyone predict the requirements of health care based on a local population ... while claiming that, "If ACOs are established in the NHS, they will be a means of delivering care and not funding it. 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 vestiges of market-based reforms remain, but they have taken a back seat as the need for NHS commissioners and providers to work together to make decisions on the use of resources has been given higher priority. Achieving the benefits of integrated care requires strong system leadership, professional commitment, and good management. It puts forward the case for a new approach that brings together funding for general practice with funding for many other services. 3 What about the data sharing all this is predicated on? 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? The King's Fund is an independent charity working to improve health and care in England. More publications about Adult social care. I would be pleased if would try answering the questions instead of fobbing me of to different websites. An example is the way in which the Care Quality Commission (CQC) has put in place local system reviews that assess how well organisations are working together to meet the needs of their populations. 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. 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. (even as "small" a component part as the odd GP going back to his/her GMS contract)? ICPs are very much a work in progress and even the most advanced examples have much work to do to realise the potential benefits. From my time in the NHS I couldn't believe that this crucial information wasn't front and centre with every CCG. What does the future hold for integrated care systems? This must be done at a local level and it takes time and requires sustained commitment. 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. 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. This is the raison d'etre of integrated care and why it should be supported. So how can the system build on this learning to bring about positive change and renewal? Little wonder then that NHSE and Mr Hunt have so far been very covert in their rollout of this project. Dear Mr Ham, The area furthest ahead in its plans to use the contract, Dudley, has identified two NHS trusts as the preferred providers, working with general practices involved in its MCP. 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. The current system of Payment by Results, which was designed for an environment in which choice and competition predominated, will then be superseded, in many cases, by population-based budgets. It replaces choice and competition, past false gods seemingly consigned to history but alive in the Health and Social Care Act. 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. Download. 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. Little wonder then that there is concern. You are not stupid and neither I suspect are people reading this Some new care models have reported absolute reductions in emergency admissions per capita. They include the following. 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. But what is happening in the areas developing ICSs, and what can others learn from their experiences? This is crucial to the ACS/ACO project (sorry, I will not use the 'integrated' word purely because it saves NHSE's and J Hunt's blushes). Integrated care systems in England: site profiles, This resource summarises key features of the current arrangements and plans in each of the eight integrated care. 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.