The NHS has embarked on a momentous, complex and hazardous journey. It is moving from a focus on individual NHS institutions to integrated local health and care systems. NHS England has called this “the biggest national move to integrated care of any major western country”. Its Next steps report outlined ambitions for sustainability and transformation partnerships (STPs) in England to evolve into accountable care systems, some of which are likely to become accountable care organisations.
There are eight local areas in England which are leading the development of accountable care systems. NHS trusts and foundation trusts are already playing a key role in this process through their STPs, by adopting new care models and by moving to accountable care structures. Trust leaders see the integration of health and care as a potential way of addressing the challenges of rising demand, responding to the growing number of individuals with more complex health needs and improving health outcomes.
The NHS has embarked on a momentous, complex and hazardous journey. It is moving from a focus on individual NHS institutions to integrated local health and care systems.Chief Executive
As the health service takes on this task, NHS trusts want a distinctive voice in shaping the new NHS landscape. Based on extensive feedback from many of the 98% of trusts that are members of NHS Providers – through our annual survey – trusts have urged us to develop a programme of support that helps them adapt to the challenges and opportunities presented by the move to accountable care.
It is clear that trusts and their STPs are at very different stages of development, and have strong views on how they should progress. As the National Audit Office has pointed out, there are significant barriers to achieving integrated care, including misaligned financial incentives, the need to change workforce profile and to share information. There is a strong appetite to share learning and, at the same time, national frameworks are struggling to keep up.
The new work programme presents an opportunity 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.
Our focus will deliberately be unique and distinctive: using our in depth knowledge and understanding of providers we will support them in the detailed practicalities of making these important transformations work and representing trusts’ views to the arm's length bodies. The programme, Supporting providers: STPs and accountable care, will be developed in close collaboration with NHS trusts over the next six weeks.
We will support trusts in forging new relationships with local authorities, primary care and commissioners. We will help them respond to specific challenges such as moving care closer to home, prioritising mental health, workforce strategy and getting the most out of the NHS estate. And we will explore new ways to support change, identifying “enablers” including new approaches to contracting, different financial flows, adopting risk stratification and whole population health management approaches, and developing STP level governance arrangements.
Our new work programme presents an opportunity 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 publicChief Executive
NHS Providers will also make the case for trusts in shaping the environment in which they operate. Priorities will include securing greater clarity from the national arm's length bodies on the purpose of STPs and how they relate to the existing statutory framework. We will also look at how the STP rating system can be developed and improved.
We will work to identify what is happening in the more innovative and advanced systems, and across the wider NHS, consulting closely with NHS England and NHS Improvement through the STP advisory group.
We will also build on existing partnerships, for example our work to publicise the early lessons from the new care model vanguards involving NHS Clinical Commissioners, the Local Government Association and NHS Confederation and will consult some of the best experts in local government, primary care and commissioning to ensure our work has the appropriate cross system focus it will clearly need.
Above all, our work is most powerful and successful when it is done in close collaboration with our members. We will consult closely with them as we prepare more detailed plans over the next few weeks. We are excited by the prospect of supporting them even more effectively as they deal with the transition to a new landscape and effect important changes.