Service Reconfiguration

31.01.18

Uncharted territory – what could 2018 bring for STPs and accountable care?

NHS Providers head of strategy, Miriam Deakin, considers the five potential themes her organisation would like to see in the year ahead as a result of emerging accountable care models.

As sustainability and transformation partnerships (STPs) and accountable care systems (ACSs) gain momentum and a handful of areas seek to implement accountable care organisations (ACOs), the year ahead could shape how health and care is delivered in the future. The prize for getting it right will be improving patient care, integrating pathways and getting better value from collective coffers. But this is uncharted territory, and with parliamentary time tied up with Brexit, aspirations for new models of accountable care must be delivered within the existing legal frameworks. Here we explore five of the wider implications which we hope to see in the year ahead:

  1. A clearer public narrative: As STPs/ACSs and ACOs gain greater prominence in the public eye, the national bodies will need to deliver a convincing narrative in support of their development, as Sir Bruce Keogh did recently. The development of STPs has raised suspicion in some quarters, and there is a real need for public and non-executive scrutiny of emerging plans. The term ‘accountable care’ has also received a mixed response, with fears it could open the door to privatisation and NHS England faces two legal challenges to the ACO contract. Locally, STPs may require national ‘air cover’ to deliver significant change which may mean difficult choices or piloting and refining new ways of working. Trusts will need time to engage their populations, build local political support, ensure plans are clinically led, and gain input from non-executives and governors. In short, building public support for any new approach to health and care will need significant investment nationally and locally;
  1. Learning from new approaches to strategic commissioning: The renewed focus on system collaboration, and population health, has real significance for commissioning in those areas where ACS and ACO plans are progressing. It is fueling diverse approaches including the planned merger of STPs in the north to offer a larger footprint for strategic commissioning, an increase in CCG mergers and shared accountable officers, collaborations between CCGs and local authority commissioners; the emergence in one area of the trust as an ‘integrator’ and the development of ACOs. The proposed procurement of at least four ACO contracts this year means the emergence a more streamlined and strategic commissioning function in those areas complemented by ‘tactical’ commissioning undertaken by the provider holding the contract. These are all exciting developments, and there will be much to learn from those taking the plunge first in weighing up the relative benefits, costs and skills required for each approach;
  1. Testing out a new balance of regulation and oversight: Given that statutory responsibilities rest with individual organisations (largely trusts and CCGs), there is a risk that, in the short term, trusts could face a two-tier system of organisational regulation and system-level oversight with the potential for double jeopardy. We know that the national bodies are committed to avoiding this and look forward to learning from the experiences of the ACSs, which have negotiated freedoms and flexibilities in return for taking collective responsibility for performance (and in some areas a shared control total) across the system. We also hope to see NHS England and NHS Improvement align their messaging much more closely this year;
  1. Trusts will invest in ‘the art of the possible’: The recent recognition by NHS England that FTs and trusts could act as the natural host organisation for the formation of an ACO is very welcome. In fact, as our recent publication with Hempsons made clear, there are a number of ways in which trusts can already form new organisations and partnerships to deliver integrated care. In the year ahead we expect to see more collaborations between trusts, either in group models, through merger or shared management teams. We also expect to see the continued development of vertical integration with primary and social care;
  1. The pace of change will vary – but everyone needs support: STPs are developing at different paces across the country, largely dependent on the quality of historical relationships as well as population size, geography and patient flow. Despite this there has been a worrying tendency for STPs to become the default footprint for delivering a range of national policy initiatives which they do not all have the local mandate, capacity or infrastructure to deliver. While funding and support for those ACSs progressing quickly is welcome, it is only right that trusts and their partners – and taxpayers – benefit from support for STPs at all stages of development. We certainly acknowledge that NHS Providers and other membership bodies have a role to play here, along with the national bodies.

More collaborative arrangements between different health services and social care have the potential to transform patients’ experiences. But how we navigate choppy waters in the year ahead may well determine how far STPs and accountable care become the natural mechanisms to deliver this in the longer term.

Top image: Marbury

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

HEE to be made ‘accountable’ to NHS Improvement

23/10/2018HEE to be made ‘accountable’ to NHS Improvement

Health Education England (HEE) will be made “accountable” to NHS Improvement, the NHS bodies have announced, alongside a number of me... more >
CQC demands Shrewsbury and Telford NHS trust submit weekly reports as part of urgent action plan

23/10/2018CQC demands Shrewsbury and Telford NHS trust submit weekly reports as part of urgent action plan

The CQC is taking urgent action at Shrewsbury and Telford Hospital NHS Trust, demanding that the trust send weekly reports detailing actions to i... more >
Struggling NHS hospital considers appealing to Tottenham Hotspur to ease financial struggles

22/10/2018Struggling NHS hospital considers appealing to Tottenham Hotspur to ease financial struggles

A struggling NHS hospital is considering appealing to a Premier League football club for financial support after ending the year with a £29... more >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital exemplars who were revealed at the same show 12 months earlier.  Jeremy Hunt also stated th... read more >

last word

Hard to be optimistic

Hard to be optimistic

Rachel Power, chief executive of the Patients Association, warns that we must be realistic about the very real effects of continued underfunding across the health service. It’s now bey... more > more last word articles >

the scalpel's daily blog

A goal without a plan is just a wish

22/10/2018A goal without a plan is just a wish

CIPFA’s health and social care policy manager, Dr Ellie Roy, makes the case for a long-term funding plan for social care, and welcomes the Public Accounts Committee’s (PAC) latest findings. The UK Government has committed to the goal of better integration of health and social care, but the financial squeeze and lack of clarity... more >
read more blog posts from 'the scalpel' >

comment

Recoup and recover

10/10/2018Recoup and recover

The ease and round-the-clock nature of making cashless payments has transformed the way we pay for goods and services – and, from now on, t... more >
The clinical voice at the heart of procurement

10/10/2018The clinical voice at the heart of procurement

Jo Gander, director of the Clinical and Product Assurance (CaPA) team, talks about their role as part of the new NHS Supply Chain. NHS Suppl... more >
Deal or no deal?

10/10/2018Deal or no deal?

Dr Andrew Dearden, BMA treasurer and Brexit lead, takes a look at what different Brexit scenarios could means for both patients and healthcare pr... more >
A push for digital in mental health

10/10/2018A push for digital in mental health

Sean Duggan, chief executive of NHS Confederation’s Mental Health Network, argues that mental health services could hugely benefit from dig... more >

interviews

Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >
Cutting through the fake news

22/11/2017Cutting through the fake news

In an era of so-called ‘fake news’ growing alongside a renewed focus on reducing stigma around mental health, Paul Farmer, chief exec... more >
Tackling infection prevention locally

04/10/2017Tackling infection prevention locally

Dr Emma Burnett, a lecturer and researcher in infection prevention at the University of Dundee’s School of Nursing and Midwifery and a boar... more >
Scan4Safety: benefits across the whole supply chain

02/10/2017Scan4Safety: benefits across the whole supply chain

NHE interviews Gillian Fox, head of eProcurement (Scan4Safety) programme at NHS Supply Chain. How has the Scan4Safety initiative evolved sin... more >

health service focus

View all News