Accountable Care Systems
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. They provide joined up, better coordinated care.
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. Specifically, ACSs are STPs – or groups of organisations within an STP sub-area – that can:
Agree an accountable performance contract with NHS England and NHS Improvement that can credibly commit to make faster improvements in the key deliverables set out in this Plan for 2017/18 and 2018/19.
Together manage funding for their defined population, committing to shared performance goals and a financial system ‘control total’ across CCGs and providers. Thereby moving beyond ‘click of the turnstile’ tariff payments where appropriate, more assertively moderating demand growth, deploying their shared workforce and facilities, and effectively abolishing the annual transactional contractual purchaser/provider negotiations within their area.
Create an effective collective decision making and governance structure, aligning the ongoing and continuing individual statutory accountabilities of their constituent bodies.
Demonstrate how their provider organisations will operate on a horizontally integrated basis, whether virtually or through actual mergers, for example, having ‘one hospital on several sites’ through clinically networked service delivery.
Demonstrate how they will simultaneously also operate as a vertically integrated care system, partnering with local GP practices formed into clinical hubs serving 30,000-50,000 populations. In every case this will also mean a new relationship with local community and mental health providers as well as health and mental health providers and social services.
Deploy (or partner with third party experts to access) rigorous and validated population health management capabilities that improve prevention, enhance patient activation and supported self- management for long term conditions, manage avoidable demand, and reduce unwarranted variation in line with the RightCare programme.
Establish clear mechanisms by which residents within the ACS’ defined local population will still be able to exercise patient choice over where they are treated for elective care, and increasingly using their personal health budgets where these are coming into operation. To support patient choice, payment is made to the third-party provider from the ACS’ budget.
In return, the NHS national leadership bodies will offer ACSs:
The ability for the local commissioners in the ACS to have delegated decision rights in respect of commissioning of primary care and specialised services.
A devolved transformation funding package from 2018, potentially bundling together national funding for GPFV, mental health and cancer.
A single ‘one stop shop’ regulatory relationship with NHS England and NHS Improvement in the form of streamlined oversight arrangements. An integrated CCG IAF and trust single oversight framework.
The ability to redeploy attributable staff and related funding from NHS England and NHS Improvement to support the work of the ACS, as well as to free up local administrative cost from the contracting mechanism, and its reinvestment in ACS priorities.
This is a complex transition which requires careful management, including of the financial framework so as to create opportunity while also reducing instability and managing risk. That’s why ACSs require a staged implementation. This also provides the opportunity to prove their ability to manage demand in ways that other areas can subsequently adopt.
We expect that candidates for ACS status to include successful vanguards, ‘devolution’ areas, and STPs that have been working towards the ACS goal. In Q1 2017/18, NHS England and NHS Improvement will jointly run a light-touch process to encourage other STPs (or coherent parts of STPs) to come forward as potential ACSs and to confirm this list. Likely candidates include:
South Yorkshire & Bassetlaw ( That will go down well 'round 'ere ! )
Nottinghamshire, with an early focus on Greater Nottingham and the southern part of the STP
Blackpool & Fylde Coast, with the potential to spread to other parts of the Lancashire and South Cumbria STP at a later stage.
Luton, with Milton Keynes and Bedfordshire
In time some ACSs may lead to the establishment of an accountable care organisation. This is where the commissioners in that area have a contract with a single organisation for the great majority of health and care services and for population health in the area. A few areas (particularly some of the MCP and PACS vanguards) in England are on the road to establishing an ACO, but this takes several years.
The complexity of the procurement process needed, and the requirements for systematic evaluation and management of risk, means they will not be the focus of activity in most areas over the next few years.
Phew ! Try reading that WITHOUT me breaking it up into bite size chunks !!!
Hertfordshire " Better Care Fund Plan " ... 2017 - 2019 ... in .pdf format ... I assume ???
https://www.hertfordshire.gov.uk/media- ... l-plan.pdf
79 pages of ... well , at least it will keep the academics happy ???
NHS Continuing Health Care ?
Covered in the main CHC thread :
https://www.carersuk.org/forum/support- ... inks-32532
Saving the local LA monies by any chance ?
Normally the starting gun for any report so commissioned ???
Norman , any updates on that campaign against cuts on your manor ?
https://www.carersuk.org/forum/news-and ... cuts-31684
Or , yet another manor now suffering ... like all others ... most since 2004 when the first wave began ... only to be followed by several more waves.
Local mp ... Stephen McPartland ?
Not quite yer average Tory ?
https://www.theyworkforyou.com/search/? ... es&column=