Making sense of accountable care

Briefing from the King's Fund - making sense of accountable care:

Constraints on NHS funding over the past seven years, combined with rising demand from a growing and ageing population, have put the NHS under enormous pressure. 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. Rather, the NHS needs to work differently by providing more care in people’s homes and the community and breaking down barriers between services.

Also see the King's Fund briefing: acccountable care explained

No hospital is an island: Acute Care collaborations demonstrate new ways of working

A new report on lessons learnt from the acute care collaborations includes case studies highlighting how vanguards are finding new ways to:

· Standardise clinical practice, pooling expertise, sharing vital patient information and analysing patient care across hospitals.

· Make better use of clinical support services, such as imaging and pathology.

· More creatively and flexibly use the skills of their healthcare professionals, reducing reliance on agency staff.

· Build innovative external partnerships with, for example, the pharmaceutical industry.

· Support more integrated health systems that champion person-centred care.

· Consolidate corporate support functions to generate efficiencies.

The report is available in full here https://www.england.nhs.uk/publication/no-hospital-is-an-island-learning-from-the-acute-care-collaboratives/ 

Using Community Partnerships to Integrate Health and Social Services for High-Need, High-Cost Patients

This briefing from the Commonwealth Fund examines the evidence on integrated community health and care services for patients with complex and multiple needs in the U.S. It identifies the five common challenges to implementing an integrated approach successfully and outlines solutions for these challenges.

Electronic prescribing to be piloted in integrated urgent care

NHS Digital has announced trials of the electronic prescription service (EPS) in integrated urgent care settings.

This will mean that patients seeking care out of hours or in urgent care settings can have their prescriptions sent directly to a pharmacy of their choice, rather than relying on paper prescriptions.

The service will reduce the time spent by doctors and others issuing prescriptions and by pharmacists dispensing prescriptions.

WHO Guidelines on Integrated Care for Older People (ICOPE)

The provision of integrated care is key for older people. The WHO Guidelines on Integrated Care for Older People (ICOPE) propose evidence-based recommendations for health care professionals to prevent, slow or reverse declines in the physical and mental capacities of older people.

STPs and accountable care

The programme from NHS Providers aims to ensure there is the right support and a strong advocate making the case for NHS trusts as they move to accountable care structures that deliver more integrated care for the public.

What is commissioning and how is it changing?

The current system is based on arrangements set out in the Health and Social Care Act 2012, which aimed to put GPs at the forefront of the commissioning process. Although the structures established by the Act have remained in place since it came into force in 2013, the way that commissioning is delivered in practice has evolved since then – and is continuing to do so.

Key changes include the delegation of some commissioning responsibilities from national to local organisations, greater joint working at a local level, and an increasingly population or ‘place-based’ approach to commissioning. All these changes are intended to support the development of more integrated systems of care, including between health and social care.

Getting into shape: delivering a workforce for integrated care

This paper from Reform focuses on the structural barriers to delivering integrated care. It studies issues such as the medical labour market, devolved workforce planning and pay, and professional boundaries.

Integrating care: contracting for accountable models NHS England

NHS England has published information on contractual arrangements for accountable care organisations.

This package clarifies how accountable models may be contracted for, how local areas would approach procurement questions and the application of the new Integrated Support and Assurance Process, run by NHSE and NHSI in relation to the award of all novel or complex procurements by commissioners. It sets out the funding model including the details of integrated budget approaches, a new Improvement Payment Scheme to replace current incentive schemes and gain/loss sharing across the local health economy to align incentives. Finally, the package describes implications for the commissioning system of new models of whole population provision.

Sustainability and Transformation Plans: five key questions for planners

This analysis from the Centre for Health and the Public Interest identifies five key questions to ask of each of England’s 44 Sustainability and Transformation Plans. It aims to set out a framework for assessing their potential impacts.

The interface between primary and secondary care: Key messages for NHS clinicians and managers

Good organisation of care across the interface between general practice and secondary care providers is crucial in ensuring that patients receive high-quality care and in making the best use of clinical time and NHS resources in both settings. This briefing document describes the key national requirements which clinicians and managers across the NHS need to be aware of. These are set out in the new NHS Standard Contract for 2017-19, under which clinical commissioning groups (CCGs) commission health services from providers, which came into effect on 1 April 2017 and which will remain in place until 31 March 2019.

• The interface between primary and secondary care: Key messages for NHS clinicians and managers
• Joint letter from NHS England and NHS Improvement

Rebooting health and social care integration: an agenda for more person centred care

This report from Localis finds that the health and social care integration agenda has a future but it is dependent on moving away from notions of structural integration and reliance on central policy direction. It concludes that the issue of funding and financial sustainability is critical but can only be influenced locally. The authors also believe that health and social care integration can create new value locally, but it must build on its most important point of consensus; greater person centred care. The report makes four strategic recommendations and six policy recommendations to support integratio

NHS moves to end “fractured” care system

The head of NHS England has pledged to end the “fractured” health and social care system that leaves too many patients “passed from pillar to post” by giving local leaders and communities more control over how they improve health and social care.

Addressing the NHS Confederation in Liverpool, Simon Stevens announced nine areas in England – covering some seven million people – which will be the forefront of nationwide action to provide joined up, better coordinated care breaking down the barriers between GPs and hospitals, physical and mental healthcare, social care and the NHS.

Eight ‘accountable care systems’ (ACSs) will bring together local NHS organisations, often in partnership with social care services and the voluntary sector. They build on the learning from and early results of NHS England’s new care model ‘vanguards’, which are slowing emergency hospitalisations growth by up to two thirds compared with other less integrated parts of the country.

Health and social care integration: roundtable write-up

This New Local Government Network (NLGN) paper summarises the discussions from two roundtable events held in January and March 2017 with officers, practitioners, elected members and thought leaders from local government and health.

The discussions focused on the challenges of implementing an integrated approach to health and social care.

How to support integration to promote care for people with multimorbidity in Europe?

The complex care needs of people with multimorbidity heighten the demand for integrated care. This European Observatory on Health Systems and Policies' policy brief identifies the most promising service arrangements for integrated care and examines how to support coordination and promote collaboration between care professionals and, strengthen professional competencies.

Shared care across the interface between primary and specialty care in management of long term conditions

Shared care has been used in the management of many chronic conditions with the assumption that it delivers better care than primary or specialty care alone; however, little is known about the effectiveness of shared care.

This Cochrane Systematic Review's aim was to determine the effectiveness of shared care health service interventions designed to improve the management of chronic disease across the primary/specialty care interface. This is an update of a previously published review.

Social care, the NHS and other services

Adult social care is part of a complex system of services and support – including the NHS. How well the various components of a person’s care are integrated can impact on their personal experience of care. This video explains the importance of different services working together to provide care. This is the fourth and final video in our 'Bite-sized social care' series intended to help explain social care in England: what it is, how it’s provided and paid for, and how it works with the NHS and other services.

• Video

Mental health and community providers - lessons for integrated care

In 2015 a group of nine mental health and community provider NHS trusts came together, hosted by the Mental Health Network (MHN), to share learning and explore how the multispeciality provider model can drive the delivery of integrated mental and physical healthcare.

This briefing explores how mental health and community provider organisations are approaching this challenge and distills the key points and lessons learned from the wide-ranging discussion.

Integrating health and social care

This report from the House of Commons Committee of Public Accounts investigates the Better Care Fund and concludes that it has missed targets for reducing emergency admissions and delayed transfers of care.

All-Wales Integrated Pathway for Children and Young People (0 to 25 years) with Vision Impairment, and their Families

The All-Wales Integrated Pathway for Children and Young People (0 to 25 years) with Vision Impairment, and their Families, created in collaboration with the Children’s Vision Service Advisory Group for Wales, provides an agreed provision pathway from the point of diagnosis of a visual impairment to adulthood.