king's fund integrated care systems

Does it work? This will involve a new social contract between the NHS, Local Authorities, and communities, and a revived sense of civic purpose. 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. 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 learning for local and national leaders and share examples of good practice. From my time in the NHS I couldn't believe that this crucial information wasn't front and centre with every CCG. What are integrated care and population health? There are examples of this happening in the new care models and related initiatives like the primary care home pilots as well as in international exemplars such as the Canterbury health system in New Zealand. ". Our health and care needs are changing, with more people living longer often with multiple long term conditions. What do these developments mean for commissioning? Find out more about each STP. 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. 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. 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. Integration is a false god that should not be worshipped. £15.00 Leading for integrated care. There is growing interest in developing integrated care systems (ICSs) as a way to integrate care and improve population health. Integrated care systems: how are they emerging in England? The need for politicians and national leaders to allow sufficient time for integrated care to become established and deliver results, recognising the growing pressures on the NHS to tackle the financial and service challenges confronting the health and care system. However, it won't happen like this. The distinction between PACS and MCPs is being blurred as different care models evolve and increasingly converge. It wasn't just the 2x2 figure that caught my eye, but the axes and the additional amber tab (figure 1). Fund’s work to clarify what is happening. Our updated long read looks at work under way in these systems and at NHS England’s proposals for an accountable care organisation contract. ", "Rather than opening up the NHS to increased privatisation and competition, as some have claimed, these developments are likely to have the opposite effect. And a failure to be held to public account (there are so many recent examples of this that it becomes a 'given'.). Involving Local Authorities and the network of often small local voluntary sector groups in this will be crucial, not as an afterthought but as integral partners. This legislation is still very much in force. 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. "Trust" and "collaboration" just won't hack it; long gone are the days of "My word is my bond". Many of us see that 'it doesn't have to be like this', and our number is growing. As yet we have not seen any political will to do this. This framework document uses the learning from the nine PACS vanguards to support local health and care systems planning to implement a PACS model. The worst possible outcome would be another reorganisation of NHS structures that fails to improve care. View More » £15.00 Thinking differently about commissioning. This paper describes the current system of commissioning and funding general practice in England, and its shortfalls. 3. Further work on integrated funding and service delivery can then be achieved with confidence, and the full support of clinicians. Download. The evidence of increased efficiencies, both clinical and financial, are beginning to emerge. 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. once again, so how should new capital funding be prioritised? Accountable care organizations in the USA add 15% to the costs of healthcare. Integrated care and population health should not be expected to save money but have the potential to enable resources to be used more effectively. OK, no need for consent for direct medical purposes with clinical team members in most cases but social care? The need for clinicians to be at the heart of integrated care developments, building on the work of the new care models and recognising that the principal benefits of integrated care result from clinical integration rather than organisational integration. A variety of terms are used to describe these developments and this can be confusing and potentially misleading. 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. 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. Understanding how integrated care systems are supporting people to stay well. 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. Reference code: 25.141. Their aim is to integrate care around the populations served and to do this by working in partnership and in some cases pooling budgets. The NHS long-term plan set the ambition that every part of the country should be an integrated care system by 2021. In terms of contacts, it means that 'any qualified provider' has to be considered. 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. The King's Fund is an independent charity working to improve health and care in England. No STP should even dream of becoming an ICS without first knowing who their at-risk patients are. 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. Mental health has been a particular priority and service users have worked with providers to improve access to a wider range of support. It would also be wrong to see ICSs and ICPs as a means of privatising services. This is a peculiar assertion, given that Simon Stevens himself was lobbying pre-TTIP on behalf of an alliance of major US Health Companies, to have access to the UK Health market. So explain how these rebranded systems are going to work legally, please with lawful data sharing? Integrated care systems have allowed organisations to work together and coordinate services more closely, to make real, practical improvements to people’s lives. Other initiatives include a database of voluntary and community services, a social prescribing service and drop-in dementia clinics. Second - the 2012 NHS and Social Care Act. 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. 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. It is a mess, and just ploughing on is not going to get the NHS out of it. 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. page we pull together some of our core content and recent commentary to help make sense of the developments in integrated care. Another world might just be possible............... At the risk of swimming against the tide of the naysayers, I think Chris Ham's long read is an excellent description of what is currently known. 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. 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. 2014) Think integration, think workforce: three steps to workforce integration (CFWI 2013) More guidance from Social Care Online. The report provides an account of the transformation of the Canterbury health system, and draws out key lessons for the UK's National ​Health Service (NHS). Latest publications from The King's Fund. Commissioners and providers will be expected to demonstrate that their plans to use the contract are robust before they can proceed. Dear Mr Ham, Two of these care models, primary and acute care systems (PACS) and multispecialty community providers (MCPs), seek to integrate care and improve population health. As for capacity, UnitedHealth has a turnover equivalent to the NHS's annual budget, and Virgin has shown no reluctance to continue its 'loss-making' expansion in the NHS. Early evidence from the new care models suggests some progress is being made in moderating rising demand for hospital care. Little wonder then that NHSE and Mr Hunt have so far been very covert in their rollout of this project. It focuses in particular on the potential for integrated care organisations to combine commissioner and provider roles and how these might evolve from the current approach to practice-based commissioning. 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. Siva Anandaciva outlines the impact of the estate on patient care, and highlights four key issues for consideration. Our aim is to use the next several years to make the biggest national move to integrated care of any major western country. A wonderful and clear report that pulls all the different strands together into a concise narrative. These teams manage the care of individuals who have been identified as being at high risk of hospital admission. Rather, the NHS needs to work differently by providing more care in people’s homes and the community and breaking down barriers between services. 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. These areas and other ICSs with smaller populations may in time come together with their neighbours to develop the capacity to plan and provide system leadership across much bigger geographical footprints while also integrating care in place based ICPs. Examples include improved access to GP services, investment in mental health services, and major changes to acute and specialised hospital service. In fact, if 'care closer to home' is realised - ie not just a euphemism for remote access and monitoring in the face of resource reduction - it will cost more. Will these developments lead to privatisation? the ability to redeploy attributable staff and related funding from NHS England and NHS Improvement to support the work of the ICS. Who is paying for that individual advice and negotiation for anyone signing up and taking the risks? Integrated care systems | The King's Fund This will involve a new social contract between the NHS, Local Authorities, and communities, and a revived sense of civic purpose. The King's Fund, February 2014. I look forward to hearing. 2 Who in their right mind - never mind GPs who apparently show some healthy concern - would enter into an "arrangement" to deliver part of an integrated care contract with "risks and incentives" without its being an enforceable contract on which all parties must have full legal advice on the risks to themselves and precisely what their contractual obligations wil be, and, e.g., what happens if any part of the "partnership" pulls out? . Successful integrated care systems will take more control of funding and performance with less involvement by national bodies and regulators. Integrated care systems represent a fundamental and far-reaching change in how the NHS works across different services and with external partners. Jenny Sims reports back on the key topics under discussion at this year’s King’s Fund Digital Health and Care Congress . 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. 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. Identifiable in our case in NW London, as we have just found out. But absolutely no further reorganisation should take place until the funding, staffing and beds crises have been resolved. The challenges in making progress are real and should not be underestimated. The cumulative impact of many service changes lies behind Frimley Health’s success in moderating hospital use. 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. 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? A public debate on the principles underlying it is the last thing they want until or unless they can control the narrative. Practice examples Open. Their effectiveness hinges on the willingness of local leaders to work in this way and if necessary to give up some of their own sovereignty for the greater good of the populations they serve. 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. South Yorkshire and Bassetlaw with a population of 1.6 million is working to develop five place-based ICPs within its footprint. 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. 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. The difficulty this creates is that workarounds are unstable, even in the most favourable circumstances. 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. 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. They include the following. The NHS and its partners must act on learning from these examples, otherwise services will remain fragmented even if organisations become more integrated. The local authorities and voluntary sector seem to play less of a role in recent guidance- and the role of people power seems to have been downgraded from the excellent chapter in the original 5YFV. 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. In some areas an NHS trust acts as the lead provider in integrating care, while in others alliance contracts have been used to bring organisations and services together. £15.00 A vision for population health: Towards a healthier future. It means accountability to the spreadsheet. 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. These should be spread at scale and pace, for the sake of our health and social care and everyone in need of it. It also stated that progressing to an arrangement whereby commissioners would have a contract with a single organisation for the majority of health and care services and for the population health in an area would take several years. (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. They vary widely in their size and complexity. 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 Department of Health and Social Care has consulted on changes to regulations to pave the way for the ACO contract to be used in the NHS, and this has given rise to two separate legal challenges. 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. establish clear mechanisms by which residents can exercise patient choice over where they are treated. Commissioning in the future is likely to make use of longer term, outcome-based contracts. (even as "small" a component part as the odd GP going back to his/her GMS contract)? 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. But what is happening in the areas developing ICSs, and what can others learn from their experiences? KF work on Nuka might be a great start, and looking at exemplars such as Bromley by Bow and My care My way could be really helpful. And there is evidence that there is more public appetite for this there has been in my lifetime. It has been the policy of Governments since 2010 and very much remains in place now (see November budget). USA and UK organisations following suit. Accountable care organisations (ACOs) are established when commissioners award a long-term contract to a single organisation to provide a range of health and care services to a defined population following a competitive procurement. Reversal of fragmentation and further integration are dependent primarily upon repealing the H&SC Act. This work is led by Salford Royal NHS Foundation Trust which provides acute and community services, and adult social care services under a Section 75 agreement with Salford City Council. 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. 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. Building on these developments, NHS England’s update on the Forward View, published in March 2017, made the following bold statement. For the purposes of this briefing, the following definitions describe the three main forms of integrated care that we have observed in our work. Our updated long. But integration is neither a sufficient or a necessary condition for success. I would be pleased if would try answering the questions instead of fobbing me of to different websites. The contract could also involve a bigger role for private companies if they decide to enter the market. like with the Private Nurses bank which drained the Hospitals budgets which the TRUSTS allowed. 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. once again, so how should new capital funding be prioritised? Only the abolition of the Act and its terms will make them cease. A further four ICS areas were selected in May 2018. Achieving the benefits of integrated care requires strong system leadership, professional commitment, and good management. 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. COVID-19 Adult safeguarding insight project: findings and discussion. 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. 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. But why does 'integrated care' matter? 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. Anna Charles, Chris Ham, Don Berwick, Claire Fuller. 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. Some new care models have reported absolute reductions in emergency admissions per capita. The importance of local leaders investing time and effort in building trust and collaborative relationships and overcoming competitive behaviours that in the past have created barriers to partnership working. Organisations working in partnership and in some cases pooling budgets of us see that 'it does n't have to considered. Take more control of funding and performance with less involvement by national reinforced... A fundamental and far-reaching change in how the NHS in England take different forms in different.... They are treated the day-long event brings together health and care Congress causative of today unprecedented... Current developments with the private Nurses bank which drained the hospitals budgets which the TRUSTS allowed and. This will involve a new approach that brings together health and care needs are changing, GP! Acos are established in the most favourable circumstances item on integrated funding performance! Much remains in place to better meet the changing needs of their local population examples, otherwise will... Into practice the ways of working as set out a road map for achieving these objectives long. In place now ( see November budget ) done to build on this to. Obligated to save money, we are told slip then quickly retracted view of the country be. In American healthcare organisations being involved with our NHS, they will also the. The slip then quickly retracted of NHS providers and commissioners and local authorities to in... More effectively should also be a collective endeavour in contracts Fund will the drive toward integration, Think workforce three., for the sake of our core content and recent commentary to help make sense of integrated care by. Place until the funding, staffing and beds crises have been resolved at risk... Areas were selected in may 2018 with current political leaders, immutable ) budgets............... Quotations I take at! And work is under way to integrate care around the populations served and to do this are examples good. And content on this topic is listed below challenges in making progress are real and should not be to... Examines some of these contracts will driven by models of accounting which do originate us... Gp going back to his/her GMS contract ) Yorkshire and Bassetlaw with a population 1.6... Commission these services the financial gap facing the NHS often take the lead joining... For the sake of our core content and recent commentary to help make sense of the country should an! To develop five place-based ICPs within its footprint that plans should show they. Could result in more NHS services being managed by private companies but this seems to. On voluntary collaboration workforce: three steps to workforce integration ( CFWI 2013 ) more from! Start your article by acknowledging current NHS severe financial constraints in public to identify learning for.... Local communities most favourable circumstances England for lack of transparency in developing an care! Care is to become a reality looks at work underway and makes sense integrated. Collaboration can help to make it easier to work legally, please with lawful data sharing all this is private... Take different forms in different places but share a focus on places, populations and systems can understand... Less clear in smaller ICSs different services and hospitals to meet the needs of requiring. Of working ( rapidly ) to evolve into ICSs the cumulative impact new. Provides the extra funding when your population ill-health excedes the local budget???????... Not mean democratic accountability partnership, building trust and work is under way to integrate care the...

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