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. 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? £15.00 Leading for integrated care. 5yfv new models include private equity and private providers, so it's unclear what end is being envisaged here. 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. 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. (even as "small" a component part as the odd GP going back to his/her GMS contract)? Find out in this paper which aims of to describe the different forms of integrated care and to summarise evidence on their impact. Integrated care systems represent a fundamental and far-reaching change in how the NHS works across different services and with external partners. “The King's Fund, an acclaimed British health authority, has published a report on the Canterbury health system – Developing accountable care systems: Lessons from Canterbury. These should be spread at scale and pace, for the sake of our health and social care and everyone in need of it. The NHS and its partners must act on learning from these examples, otherwise services will remain fragmented even if organisations become more integrated. And what will it mean for patients? 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. This fact of life does not deter them however from trying again and often winning again. Drawing on the experience of the north-east Hampshire and Farnham PACS and similar work in Surrey Heath, GP practices have collaborated to provide same-day access to patients requiring urgent appointments, and community services have been aligned more closely with GP practices and adult social care. It is hard to envisage how private companies would perform better financially than NHS organisations when they would be taking responsibility for the services provided by these organisations if they competed successfully for an ACO contract. 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. The aim of this briefing is to explain what is happening in practice drawing on our work with the NHS and local government. "Workarounds" render the whole system incoherent and vulnerable to destabilisation, complex contracts and instability of providers. It puts forward the case for a new approach that brings together funding for general practice with funding for many other services. The worst possible outcome would be another reorganisation of NHS structures that fails to improve care. 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. The need to put in place incentives (financial and non-financial) to stimulate emerging models of integrated care to deliver improved care and outcomes for their populations and avoid becoming unresponsive monopolies. First - the money. Early evidence suggests that these changes have led to year-on-year reductions in emergency admissions to hospitals. 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. Integrated care partnerships (ICPs) are alliances of NHS providers that work together to deliver care by agreeing to collaborate rather than compete. 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. Virgin has already shown its willingness to sue the NHS. Speaking as someone representing an MCP which has achieved some success (ref this week's HSJ article) I can see and measure the improvements in patient care, patient experience and staff satisfaction from our work, and that of others. Rather than opening up the NHS to increased privatisation and competition, as some have claimed, these developments are likely to have the opposite effect. Will these developments lead to privatisation? Prof Ham states that ICS won't save money, which is problematic for the 44 STP areas obligated to save £22bn. 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. Latest publications from The King's Fund. Our health and care needs are changing, with more people living longer often with multiple long term conditions. ICSs are at a much earlier stage in their development with Greater Manchester being the most developed. A variety of new care models has been put in place to better meet the changing needs of the population. To begin with, only a few areas have expressed an interest in using the contract; others are using existing legislative flexibilities to develop integrated care. Integrated care systems: how are they emerging in England? This will involve a new social contract between the NHS, Local Authorities, and communities, and a revived sense of civic purpose. Trust and The King’s Fund, examines some of these new models and their potential for delivering better outcomes at lower cost. "Trust" and "collaboration" just won't hack it; long gone are the days of "My word is my bond". There will be no more money, we are told. 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. What are integrated care and population health? 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.")? 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. Breaking down barriers means co-ordinating the work of general practices, community services and hospitals to meet the needs of people requiring care. A learning network for anyone involved in developing an integrated care system (ICS) in their area. Hosted by The King’s Fund, the day-long event brings together health and care professionals to discuss all things integrated care. 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. These teams manage the care of individuals who have been identified as being at high risk of hospital admission. The importance of engaging fully with local authorities and other partners and avoiding an NHS view of the world taking precedence. And discontinuity (as one private company buys out another). Some forms of integrated care involve local authorities and the third sector in working towards these objectives alongside NHS organisations. COVID-19 Adult safeguarding insight project: findings and discussion. The importance of demonstrating tangible improvements in health and care while at the same time putting in place the governance, leadership and funding models needed to support integrated care. 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. It will lead to fragmentation. Kings Fund Integrated Care Summary Integrated Care - What is it? This means tackling risk factors such as obesity and redoubling efforts to reduce health inequalities. You are not stupid and neither I suspect are people reading this It would also be wrong to see ICSs and ICPs as a means of privatising services. Examples include improved access to GP services, investment in mental health services, and major changes to acute and specialised hospital service. comparing approaches across the different areas to identify learning for others. And there is evidence that there is more public appetite for this there has been in my lifetime. Our aim is to use the next several years to make the biggest national move to integrated care of any major western country. Mental health has been a particular priority and service users have worked with providers to improve access to a wider range of support. like with the Private Nurses bank which drained the Hospitals budgets which the TRUSTS allowed. Integrated care systems | The King's Fund They have emerged through the leadership of NHS organisations rather than via market testing and they are an example of partnership working in the public sector. Will the drive toward integration, system-working at place and in integrated care systems be sustained? It has been the policy of Governments since 2010 and very much remains in place now (see November budget). The jargon of 'integrated care' is much-used in health policy and management circles. In law. It is a mess, and just ploughing on is not going to get the NHS out of it. Rather, the NHS needs to work differently by providing more care in people’s homes and the community and breaking down barriers between services. ", 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. They depend on NHS organisations putting in place governance arrangements such as memoranda of understanding and partnership boards that enable them to make progress within the existing statutory framework. These developments are being implemented at a time when NHS finances are under huge pressure and, as a result, have been interpreted by some as a means of cutting spending and services rather than improving care. 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. page we pull together some of our core content and recent commentary to help make sense of the developments in integrated care. 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. Recognising that the NHS is required by parliament to keep within its spending limit, and that this is proving difficult, these developments are primarily about improving health and care, and in so doing seeking opportunities to deliver its financial objectives. 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 … 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. 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. 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. 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. But absolutely no further reorganisation should take place until the funding, staffing and beds crises have been resolved. Thus the financial heart of these contracts will driven by models of accounting which do originate in US healthcare thinking. The need to ensure that national regulators change their ways of working (rapidly) to support developments in the NHS. 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. 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