Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England | Chris Ham | The King’s Fund
NHS England has recently changed the name of accountable care systems to integrated care systems. In this updated long read, Chris Ham looks at work under way in these systems and at NHS England’s proposals for an accountable care organisation contract.
The article looks at the following:
Why is change needed?
What are integrated care and population health?
What’s happening with new care models?
What’s happening in integrated care systems?
What are ACOs and why are they controversial?
How are integrated care systems and partnerships developing?
What has this way of working achieved?
What do these developments mean for commissioning?
Are these developments really a way of making cuts?
Will these developments lead to privatisation?
The author concludes that integrated care should be supported as it is the best hope for the NHS and its partners to provide services to meet the needs of the growing and ageing population.
A new blog post on The King’s Fund identifies five ways to improve the morale of junior doctors. Bilal Sahib writes that, “dissatisfaction among junior doctors has reached unprecedented levels: 80 per cent feel excessively stressed, and the number progressing directly to specialty training is declining.”
While Sahib recognises some of these solutions can only be implemented at a national level, for instance boosting the number of medical school places. There are some that could be implemented at a local level which could help to bolster the morale of this workforce. Their suggestions include:
Better rota planning
Out-of- hours support
Full details about the suggestions and further details can be found at The King’s Fund
Related: A retrospective analysis on BMJ Open looks at the impact of industrial action by English junior doctors in 2016. This is the first UK study that looked at the effects of striking junior doctors, as well as the first to evaluate the impact of withheld inhospital emergency services (the April 2016 strike was the first ever UK strike to include emergency care).
The full analysis can be downloaded from the BMJ here
NHS England have produced a case study looking at how a mental health service, Back on Track IAPT (Improving Access to Psychological Therapies), formed a wellbeing team to examine employees’ perceptions of their workplace and the challenges they face. Case Study Summary: Challenges such as stressful situations and day-to-day demands prompted the formation of a wellbeing team to examine employees’ perceptions of their workplace at Back on Track IAPT service, Hammersmith and Fulham. Based on feedback a range of changes were made to working arrangements to raise staff wellbeing.
The challenge: staff fed back that their wellbeing was being affected by working long hours and having to manage stressful clinical situations, particularly management of risk.
How it worked: A wellbeing team was formed and funding and study leave was arranged so that wellbeing team members could attend relevant continuing professional development . This ensured that they were able to learn from best practice in other areas. The wellbeing team then sent an anonymous survey to all team members asking the following questions:
Does Back on Track care about my wellbeing?
To what extent do you feel able to raise and discuss difficult and controversial topics?
How comfortable are you in meeting your role demands?
Am I able to adopt a healthy work-life balance?
Is my mental health good?
Is my physical health good?
Are my energy levels high?
Am I well, resilient and performing at my best?
Responses were categorised according to groups: High Intensity Therapists, Psychological Wellbeing Practitioners and administrative teams to identify themes within each group.
Next steps: Changes have been made- the service now offers a short ‘mindful walk’ for employees each week. There are also plans to use a standardised questionnaire to assess wellbeing to help benchmark the service in the future, as well as starting a small gardening project in the patio at the back of the main team base.
“The Budget on 22 November 2017 contained some obvious good news for the NHS: it provided more money, if not as much as we hoped. With more money comes the inevitable re-set of NHS plans and the new planning guidance came out on 2 February.
This is desperately late in the day given the new financial year starts on 1 April but was inevitable given the financial settlement for the NHS changed so significantly at the last minute,” writes Richard Murray, Director of Policy at the King’s Fund.
You can read Murray’s full piece about what the guidance didn’t say, and also provides a commentary on some of the key changes around money, performance and reform
According to Age UK, 1 in 3 people with dementia are not receiving the NHS support they need. Age UK has warns of an urgent and growing need to provide much better support for individuals diagnosed with dementia. The press release is available here
In response to these findings, Age UK has published a report which outlines a a number of interventions that are evidenced, cost effective and scalable, and which could be replicated by NHS Trusts, care providers and primary care services.
This report focuses on what works in supporting people with dementia to live well –looking at services and supports beyond the traditional domains of health and care services.
It was developed through a programme of work rooted in a rights-based approach to
dementia, and in the social model of disability. The programme focused on what people with dementia told Age UK ‘living well’ meant to them.
The key factors identified were broadly grouped under three domains of quality of life:
• personal wellbeing
• positive relationships
• active daily lives.
The report showcases approaches which relate to these three domains, either directly or by improving key aspects of life which people with dementia said were related to their quality of life (such as social connection, sense of self-worth, getting on with day-to-day activities).
It also proposes a new framework for understanding these approaches, to help to make sense of the way in which these approaches could be brought together in communities. Alongside this it also signposts interventions, and there are also a number of case studies from a number of organisations, programmes and services.
Age UK| Promising Approaches to living well with dementia
The National A&E Dashboard has been developed by NHS Improvement to provide a consolidated view of A&E information and can be shared between various central NHS bodies.
The dashboard provides a consistent understanding of A&E performance through the collection of daily situation report (SitRep) data, and enables the NHS to identify pressure points in the system and intervene accordingly.
Data is submitted by trusts on a daily basis for the previous 24 hours and snapshots of the data are taken at 8am. Trusts submit this data in the morning and submissions close in the afternoon for reporting purposes.