Accountable care

Accountable care: policy fad or step forward on the journey towards integrated care? | Nicola Walsh |The Kings Fund

Accountable care is under discussion almost everywhere in the NHS. Groups of NHS providers (sometimes with the local commissioner) are exploring how they can work more closely together to take on the responsibility for the health and care of a given population within a given budget. Currently, we are seeing emerging accountable care arrangements adopting various forms according to local needs and preferences: in some areas the focus is on creating a single organisation; in others, organisations are keen to use the words ‘system’ or ‘partnership’ – to reinforce the notion of working together.

In this Kings Fund blog, Nicola Walsh looks in more detail at Accountable Care Systems and partnerships.

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Getting into shape: Delivering a workforce for integrated care

This paper 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 | Reform

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Image source: Reform

The Government is rightly committed to a radical reshaping of NHS delivery, based on a shift to new care models and treatment in the community. Its management of the NHS workforce, however, has not delivered with nearly three times more doctors, and four times more nurses in the acute sector than in the community. Since 2009, the number of consultants has risen by nearly a third, whilst the number of GPs has fallen.
Freedom of Information requests made for this report found that, across 61 acute trusts, only 6 per cent of consultants work in the community for at least one session per week.

As the Government and the NHS leadership have repeatedly said, the priority for the NHS is to increase its speed of innovation. To do this, the NHS is rightly seeking to devolve decision-making and to deregulate. For the workforce, however, policy remains highly centralised and tightly regulated. This paper shows how to bring the same reform ideas to the workforce as the NHS is applying to other areas.

Hospital-Community Partnerships To Build A Culture Of Health

This compendium features detailed descriptions of hospital-community partnerships from across the United States that have made substantial improvement addressing priority health needs in their communities | American Hospital Association

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Image source: AHA

These hospitals and communities vary in location, service type, type of partners and degree of partnership. All participated in Learning in Collaborative Communities, led by the Health Research & Educational Trust and supported by the Robert Wood Foundation.

Priority needs that the featured hospital-community partnerships are addressing include:

  • Chronic disease management
  • Health care access
  • Mental and behavioral health
  • Obesity
  • Preventive health practices
  • Social determinants of health
  • Substance use disorders
  • Violence

Partnerships are important because individuals and organizations share valuable insights, tools and resources. Lessons learned from successful partnerships motivate other partnerships to implement effective strategies in their organizations. The case studies in the compendium describe effective partnerships and programs to create a Culture of Health, their impact and lessons learned.

Read the full report here

Integrating care

Integrating care: contracting for accountable models | NHS England

This guidance provides support for early accountable care organisations (ACOs) and outlines the new contractual framework for ACOs and how to establish the care model in practice.

The guidance covers the following:

  • New models of care
  • A new contractual framework
  • Establishing the care model in practice
  • Supporting documents
  • Key changes made in the Contract and supporting documents
  • Planned changes to regulations to support the development of ACOs
  • Further development of the Contract – and its use in practice

The document can be downloaded here

Rebooting Health And Social Care Integration: An Agenda For More Person Centred Care

This report 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 | Localis

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Image source: Localis

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 integration.

Integration and Better Care Fund Policy Framework

The Better Care Fund will provide financial support for councils and NHS organisations to jointly plan and work together to deliver local services.

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This document sets out the story of integration of health, social care and other public services, and provides an overview of related policy initiatives and legislation.

It is intended for use by those responsible for delivering the Better Care Fund at a local level (such as clinical commissioning groups, local authorities, health and wellbeing boards) and NHS England.

It includes the policy framework for the implementation of the statutory Better Care Fund in 2017 to 2019, which was first announced in the government’s Spending Review of 2013 and established in the Care Act 2014.

It also sets out proposals for going beyond the Fund towards further integration by 2020.

The Social Care Institute for Excellence’s report, Integration 2020: Scoping research, has also been published.

Full paper: Integration and Better Care Fund Policy Framework 2017 to 2019

Total transformation of care and support

The Social Care Institute for Excellence has published Creating the five year forward view for social care: how transformed and integrated health and care could improve outcomes and cost-effectiveness.

This updated paper explores the potential for scaling up the most promising examples of care, support and community health services, initially using data from Birmingham City Council, modelling their outcomes and costs.  Originally published in November 2016, it has been updated to include additional models.

The report contains the following chapters:

Vision for transformed care: Re-shaping services around the needs and strengths of individuals, families and communities.

Key messages and summary: Outcomes can be improved, and costs reduced, if the sector scales up promising practice.

Case studies: Six models of care and their potential impact on costs and outcomes.

Models of care: Overview of promising practice that support transformative change in health and social care.

Conclusions and next steps

The paper is available to download here