Next Steps on implementing the Forward View: Accountable Care Systems Jacob West National lead new care models programme
In October 2014 the Five Year Forward View identified five new care models that are being deployed in fifty Vanguards across England 1. Primary and Acute Care Systems (PACS): joining up GP, hospital, community and mental health services 2. Multi-speciality Community Providers (MCP): moving specialist care out of hospitals into the community 3. Enhanced Health in Care Homes: offering older people better, joined up health, care and rehabilitation services 4. Acute Care Collaborations: linking local hospitals together to improve their clinical and financial viability, reducing variation in care and efficiency. 5. Urgent and Emergency Care: new approaches to improve the coordination of services and reduce pressure on A&E departments
Early evidence shows reductions in hospital use from the population based care models (1)
Early evidence shows reductions in hospital use from the population based care models (2) Principia, Nottinghamshire Enhanced support for older people living in 23 care homes by: - aligning care homes with general practices - regular visits from a named GP - improved support from community nurses - independent advocacy and support from the third sector - engaging and supporting care home managers Evaluation linked care home and hospital data, and compared Principia care home residents to a matched control Showed reductions in: - A&E attendances (-29%) - Acute admissions (-23%)
In December 2015 the NHS launched a five-year strategic planning round through 44 Sustainability and Transformation Plans to extend system leadership Planning by individual institutions will increasingly be supplemented with planning by place for local populations. For many years now, the NHS has emphasised an organisational separation and autonomy that doesn t make sense to staff or the patients and communities they serve. System leadership is needed.
The 44 Sustainability and Transformation Partnerships (STPs) are now established across England Populations ranging from 0.3 to 2.8 million Not new statutory bodies but partnerships between existing NHS organisations and local government All at difference stages of development and moving at different speed Each will work according to the needs of different parts of the country Named single leaders in place
In March 2017 the NHS published our Next Steps on the Forward View, which included a commitment to create Accountable Care Systems as evolved STPs ACSs will be an evolved version of an STP that is working as a locally integrated health system. They are systems in which NHS organisations (both commissioners and providers), often in partnership with local authorities, choose to take on clear collective responsibility for resources and population health In return they get far more control and freedom over the total operations of the health system in their area; and work closely with local government and other partners to keep people healthier for longer, and out of hospital.
ACSs are bringing together existing health and care organisations to make faster progress on delivering national priorities NHS organisations (commissioners and providers), often in partnership with local authorities, take on collective responsibility for resources and population health, providing joined up, better coordinated care. Fast national track priorities - taking strain off A&E making it easier to see a GP, improving access to cancer and mental health services. More control over funding available supporting transformation. Accountability for improving health and wellbeing of population. 8
ACSs are partnering with NHSE/I to implement concrete steps to demonstrate the potential of this model 1. Improve services by delivering existing commitments more effectively, rather than committing to new things 2. Take whole-system accountability for improving outcomes by working together within the available resources, rather than operating in silos 3. Creating shared decision-making arrangements across existing organisations, rather than restructuring organisations 4. Showing how to integrate clinical services using new care models, rather than continuing to provide fragmented and badly coordinated care 5. Using data and public engagement to understand the real needs of the population to improve prevention and support effective self-management
Eight ACSs were launched in June after submitting Expressions of Interest, closely aligned to two devolution areas Eight ACSs Two Devolution Areas 1. Frimley Health 2. South Yorkshire & Bassetlaw 3. Nottinghamshire 4. Blackpool & Fylde Coast 5. Dorset 6. Luton, with Milton Keynes and Bedfordshire 7. Berkshire West 8. Buckinghamshire 1. Greater Manchester 2. Surrey Heartlands We hope that further rounds of ACSs will launched over the coming years as more systems become ready to bear accountability
NHSE and NHSI are co-producing a Development Programme with national teams and lead ACSs 1 2 3 Workstream Accelerating service improvement Finance and Efficiency Leadership and Governance Sub-Topics Clinical improvements in priority areas: Cancer, Urgent and Emergency Care, Mental Health, Primary Care, Maternity Capital and transformation funding, payment models, efficiency, shared system control totals Governance models, leadership development 4 System Design Commissioning, oversight 5 6 Population health management Communications and public engagement Public health, external partnerships and data Local, regional and national Each workstream is jointly led by ACSs and NHSE/I leads, coordinated by the central ACS team. We host regular events for ACSs and workstreams to share learning