Chris Ham had produced a thought provoking article (read it here) on behalf of the Kings Fund, which looks at the decision by NHS England (NHSE) to rename accountable care systems as integrated care systems, and asks what does this mean for the NHS in the medium term?
The recent publication from NHSE, Refreshing NHS Plans for 2018/19, has a whole section dedicated to Integrated Care Systems, which is now the collective term for both devolved health and care systems and those systems previously known as ‘shadow accountable care systems’. Integrated Care Systems bring together local authorities and NHS commissioners and providers to meet the needs of their local population. Whilst NHS organisations will still be accountable to NHSE and NHS Improvement (NHSI), and local authorities remain accountable to their communities, many systems are developing processes of mutual accountability between all involved organisations.
Mutual accountability relies on a high level of trust between all organisations, with stringent governance arrangements in place to support the high levels of collaboration necessary. There is no basis in law to support Integrated Care Systems, therefore they are reliant upon the organisations involved to sometimes put the interests of the wider community before their own. They also rely on NHSE and NHSI to work together to support them in the short term – with most Integrated Care Systems becoming self-governing in the future.
This NHSE publication clearly states that Integrated Care Systems will play a major role in the planning and management of services and resources in the future. The 10 Accountable Care Organisations (now relabelled Integrated Care Systems), already in existence, will, in 2018/19, prepare a single system operating plan and become responsible for system control. It is expected that other systems will join this programme when they have the maturity to demonstrate a proven delivery track record, strong leadership, robust financial management and planning.
NHSE is sending a clear message: system working is here to stay.
Integrated Care Systems are aimed at making sense of the Health and Social Care Act 2012 without having to go through any changes to the law. However, there is a danger that, without a legal framework, informal processes such as Memorandum of Understanding, Partnership Boards etc, may not be robust enough to stand up to difficult challenges, decisions or public scrutiny.
Nevertheless, concerns of ‘backdoor privatisation’ raised around the proposed national contract for accountable care organisations, (to be used as part of a procurement process), remain, and NHSE has agreed to delay the introduction of this contract until a consultation process has been completed.
The author questions the necessity of this proposed contract, when many areas are already using existing contractual flexibilities, such as alliance and lead provider contracts, to move towards integrated care through the alignment of NHS providers such as hospital, mental health and community services, with GP services and social care services.
However, in these areas, there are tensions due to the collaborative nature of these contracts between commissioners and providers, posing difficulties for the Clinical Commissioning Groups (CCGs) when determining if they need to undertake a competitive procurement process. Many CCGs are anxious they may face a legal challenge from private companies who feel excluded from such contracts.
The author concludes that while there is no political will to align the law with integrated system and partnership working, then the NHS will have little option but to continue to muddle through the ambiguities and tensions which will inevitably arise.
To read the full report from Chris Ham for the Kings Fund please click here.