As we all know, NHS funding constraints combined with an unprecedented rising demand on services is putting the NHS and staff under immense pressure. Continuing as we are with the current hospital based model is not an option and instead we need to consider how we can work differently, moving care into the community and into people’s homes and breaking down barriers between multiple services.
There is also a wider and longer lasting issue… how do we tackle the wider determinants of health and how does this link with the current state of the NHS? Whilst the recommendations of the Marmot report were welcomed back in 2011 with the government placing the reduction of health inequalities at the heart of public health plans, arguably limited progress has been made. Public health provision and the NHS often feel like slightly distant relations than hand in hand siblings. What could both sides do here to lead public health in an new, transformational, innovative and long lasting way?
The current zeitgeist is around accountable care… why? A bold statement from NHS England in March 2017… “Our aim is to use the next several years to make the biggest national move to integrated care of any major western country”. This aim is being considered by STPs, through the new care models and through a variety of other developments that are collectively labelled ‘accountable care’ which is in essence, integrated care. But how to we join the dots, how do we work better ‘together’ to meet the needs of our local populations?
A recent report by the Kings Fund provides a comprehensive look into all aspects of accountable care and will answer all of your questions. What does it mean for commissioning? What’s happening with new care models? What’s happening in accountable care systems? What has accountable care achieved? Is accountable care about making cuts and privatising services? Where next?
Geographical areas including Northumbria, Salford, South Yorkshire, Morecambe Bay, East Somerset, Nottinghamshire, and Cornwall are leading the way in the exploration of these approaches by utilising preexisting legislative flexibilities so they can integrate care with public providers.
These developments sound promising and may hold the key to a different way of working for the NHS where the emphasis is no longer on organisations but on systems, places and people. Whilst the potential privatisation of the NHS is thrown around the media, accountable care systems are likely to have the opposite effect with collaboration rather than competition being at the heart.
Nevertheless, accountable care is not a panacea and faces many many challenges in moving forward and making real progress and these should not be underestimated. Like all things, it will require skilful implementation to deliver its vision. However, what it does offer is a sense of hope for the NHS and partner agencies, that we can provide high quality, integrated health care which meets the needs of our local populations, and keeps them out of hospital.
To read the full Kings Fund Report ‘Making sense of accountable care’, please click here.