integrated care systems (ICSs), bringing together commissioners and providers of NHS services with local authorities and other partners to plan and manage services that benefit from being considered at greater scale than can be undertaken at place What will be the models for new provider collaboratives and how will they be structured to enable mutual support between provider organisations and effective co-operation within sectors at the level of place? ‘Integrated care’ is a term that reflects a concern to improve patient experience and achieve greater efficiency and value from health delivery systems. The Court of Protection under self regulation is under no obligation to explain their conduct. However, this commitment will not apply to CCG chief officers or members of CCG governing bodies and boards under option two, whose roles will be ‘more directly impacted’. The publication does two things: first, it sets out the next steps towards integrated care, continuing a journey the NHS has been on for many years and most recently articulated in the NHS Long Term Plan, and second, in the light of this updated model for the health and care system, the document also sets out options for legislative change. Is the integration of health and social care moving too fast for the current legal framework? For the NHS, at its core this will combine primary care, community health and mental health services but can include more. Evidence-based information on involving patients in their care plan from King's Fund for health and social care. next 10 years. Integrated care systems have allowed organisations to work together and coordinate services more closely, to make real, practical improvements to people’s lives. It puts forward the case for a new approach that brings together funding for general practice with funding for many other services. This would be a formal NHS organisation and would replace CCGs. This report is based on interviews with eight of the ‘first wave’ ICSs to understand how they are developing and to identify lessons for local systems … See our Privacy Policy and User Agreement for details. The evidence base for integrated care 1. Key questions What do we mean by integrated care? This will bring together funding for primary care, clinical commissioning group (CCG) budgets and much of specialised commissioning (though these will still be based on nationally determined standards) into one pot, with the intention to move to a more strategic outcomes-based approach. How will the cultural change that underpins better integration be supported? ICSs combine the places within their footprints, provider collaboratives and partnership working with other bodies. Mental health problems are very common in the community; 90%of adults with mental health problems are supported largely or exclusively by primary care. While professional self regulation and the belief that unidentified 'experts' can be trusted to make up their own rules, society will continue to have needless conflicts. But what are they? Before joining the Fund in January 2014, Richard was chief analyst at NHS England and previously held a number of roles at the Department of Health, including director of strategy, director of financial planning and chief economist. A key part of the NHS long-term plan, primary care networks (PCNs) will bring general practices together to. This would create a mandatory board and would allow the partners to make decisions collectively. Integrated care systems represent a fundamental and far-reaching change in how the NHS works across different services and with external partners. Our new long read discusses how lessons from the recent history of NHS finances can help the system plan for the future. We will continue to review additional information as it becomes available. The future landscape for the NHS and its partners will be made up of four interlocking elements: Although not a major focus of the document, in practice these tiers will build on, and will need to support, work at the level of local neighbourhoods, where primary care networks (PCNs) will join up primary and community services. A project that looks at the process of change and lessons learned to date in Trafford, where NHS organisations have been working on the development of an integrated care system across the whole health economy. NHS England and NHS Improvement has now put forward two further options. Clipping is a handy way to collect important slides you want to go back to later. Despite the disappointments, successive governments have remained convinced that their latest round of payment reform would finally create a self-improving health system. By Professor Sir Chris Ham - 25 October 2018, A recipe for baking in collaboration? Integrated care in Northern Ireland, Scotland and Wales examines the context in which health and social care is provided; identifies policy initiatives that promote integrated care and the impact of these initiatives; and considers the barriers and challenges to achieving integrated care. This. How will delegation of functions (and budgets, in some cases) to the level of place be supported in practice? Related reading * A vision for population health * A year of integrated care systems: the journey so far * Delivering integrated care: learning from experience I believe that had I paid a lawyer £2000 to fill in the forms for attorney would have been decided within one week. NHS England and NHS Improvement had proposed a set of legislative changes in 2019 which it believes ‘still stand’. Leading for integrated care. While NHS England and NHS Improvement has set out a roadmap for the future direction of the NHS and its co-operation with partners, there are questions about how this will work, though many of these pre-date these new legislative proposals. The King's Fund - On Christmas Eve 2020 a new EU-UK trade and co-operation deal was agreed. The potential benefits of working at this scale include collaborating to reduce unwarranted variation, reducing inequalities of access, improving workforce planning and making efficiencies in clinical support and corporate services. identifies five steps to support the continuing transformation by aligning regulation, policy and practice. With the insurance I had no guarantee that they would not prevaricate further. making sense of systems, places and neighbourhoods, Integrated care services represent a fundamental shift in the way the health and care system is organised. Many believe that previous attempts at NHS reform have suffered from a top-down, one-size-fits-all approach. NHS England and NHS Improvement’s proposals for new legislation, NHS England and NHS Improvement’s latest legislative proposals show a desire to fast forward the integration agenda, but. Richard Murray reflects on the proposals. s the national rhetoric focuses on supporting the delivery of population health and integrated care, different models of care and new ways of working are being implemented across England. ICSs will also be given increased control over capital spending. Vision for a System of Integrated Healthcare Homes, Page 1, 12-17-10 Integration Discussion Draft Distributed 12-20-2010 Executive Summary In March 2010, Congress enacted a sweeping set of changes to the American healthcare system with the passage of the Patient Protection and Affordable Care … This report explores the progress, challenges and opportunities the move towards greater integration presents, through interviews with 16 people leading or chairing an integrated care system or sustainability and transformation partnership. Returning for its ninth run, The King Fund's conference gives you the opportunity to interact with our policy experts, who will guide you through the latest health and social care data and explain how the system in England really works. Leaders explained that successful systems need to look methodically at which services can be delivered at scale by the STP and which are best The King's Fund integrated care summit 2018 As the national rhetoric focuses on supporting the delivery of population health and integrated care, different models of care and new ways of working are being implemented across England. This content relates to the following topics: On 26 November, NHS England and NHS Improvement published Integrating care: next steps to building strong and effective integrated care systems across England. There will be a designated leader for place ‘on behalf of the NHS’ who will help to co-ordinate the shared work at place of bolstering primary care services, integrating health and care services and the broader agenda around promoting good health, although the details of the role remain to be clarified. Related reading. There is an expectation that ICSs then delegate some spending and functions to place level. How will staff at all levels be supported to genuinely collaborate across organisational and professional boundaries? I paid the Court of Protection £400 to have responsibility for my demented wife's finances. Especially concerned about the standing of PPG's within Primary Care. NHS England and NHS Improvement believes that, since those earlier proposals, the need and appetite for enshrining ICSs in legislation has increased, in part due to the greater partnership working between NHS bodies and their partners observed during their response to Covid-19. Option one: to create a statutory ICS board, with an accountable officer. This explainer looks at how these bodies are structured and the progress made before the Covid-19 (coronavirus) outbreak took hold. The aim is to address fragmentation in patient services, and enable better coordinated and more continuous care, frequently for an ageing population which has increasing incidence of chronic disease.' Judith Smith and Chris Ham: Commissioning integrated care - what role for cli... Judith martin east cheshireic 7nov2012 v2, Steve Laitner on integrated care - innovations in the UK, Naomi Fulop: Integrated care lessons from the research, Peter Colclough & Paul Mears: Integrated care in Torbay, No public clipboards found for this slide, A/Director of Training, GP Pathway at Blacktown Hospital, Executive Consultant at Desai Management Consulting. Many believe that previous attempts at NHS reform have suffered from a top-down, one-size-fits-all approach. At ICS and collaborative level, clinical networks should be able, for example, to undertake clinical service reviews and develop recommendations for the ICS and collaborative. • Towards integrated care in Trafford. You will hear balanced and honest views about the pressures and opportunities facing the system in 2021. Case studies Find out how local partnerships across the country are adapting to meet the health needs of their populations. How are they funded and held accountable? Nick Goodwin and Judith Smith's slidepack explores what we mean by integrated care and what can be done to support its development. It has features in common with accountable care organizations in the United States. The King’s Fund proposes approach for improving the performance of health services. Looking to the system, seeing the bigger picture System leadership ≠ organisational leadership System leaders are facilitative and enabling, not pace setting • Leaders are learning on the job I’ve learnt more about how local authorities work in the past 18 months than I’ve done in the previous 42 years. A vision for population health; A year of integrated care systems: the journey so far; Delivering integrated care: learning from experience In some cases, horizontal collaboratives will operate across multiple ICS footprints. The paper draws on three years’ development work with leaders in health care systems in north-west England, undertaken by the Advancing Quality Alliance (AQuA) and The King’s Fund which has adopted a ‘discovery’ approach to developing integrated care and the leadership capabilities supporting it. work at scale. Objectives Over the past 12 months, there has been increasing policy rhetoric regarding the role of the National Health Service (NHS) in preventing disease and improving population health. Aside from the largely organisational changes set out above, there are a number of common themes running through the changes. In addition, the document refers to the need for parliament to define in legislation the mechanisms by which the formally merged NHS England and NHS Improvement will be held to account, both by the Secretary of State for Health and Social Care and by parliament itself. The exact division of roles and responsibilities between a place and the host ICS will be based on the principle of subsidiarity so that an ICS only takes on responsibility for things where there is a local need to work at greater scale. without further detail it’s hard to reach a view. I think Integrated care systems are made up of three major pillars of work: primary care networks, personalised care and population health management. You can change your ad preferences anytime. Case studies Find out how local partnerships across the country are adapting to meet the health needs of their populations. Aims. The NHS in England aims to be paperless by 2020.Appropriate then, that a review of data security in the NHS should be launched at this year’s King’s Fund Digital Health and Care Congress in London on 5 and 6 July. For staff, improved collaboration can help to make it easier to work with colleagues from other organisations. See our User Agreement and Privacy Policy. Further details of our integrated care work can be found at: Alongside subsuming CCGs, many NHS England commissioning functions would be delegated to the ICS. Until further detail is made available, it is difficult to assess the legislative proposals fully. Long read Search results Jump to search results. Providers may find themselves part of both horizontal collaboratives at ICS level, and vertical collaboratives at place. It concludes by identifying some of the remaining questions that will determine how this proposed package will work. However, the proposals on legislation set out alternative paths for the future of ICSs and we return to this in later sections. Specialist clinical leadership will be present in both ICSs and horizontal provider collaboratives and, where appropriate, at regional and national level as well. Whilst acknowledging that health is not a significant EU competence, the authors believe there could be major implications for health and social care due to political and economic instability. And what difference will they make? For most people their day-to-day health and care services will be organised at place level, where a wide range of partners will work together to meet the health and care needs of local populations. The document makes clear that horizontal provider collaboratives will include every such provider within an ICS, eg, all acute trusts in an ICS will be part of an acute provider collaborative. However, the previous proposals did not include putting ICSs on a statutory footing, instead proposing a new statutory underpinning to establish ICS boards through voluntary joint committees. If you continue browsing the site, you agree to the use of cookies on this website. 3,4. It seems that the future is steering away from local involvement unless I can be otherwise persuaded. Collaboratives will have mandated representation at ICS level in the systems in which they operate, alongside representatives of place and other organisations. The case for integrated care, calls for the NHS to be re-orientated and based on stronger collaboration between health professionals and more effective organisation of services. In this way, collaboratives will help to set ICS priorities and allocate resources alongside contributing to place-based working. Achieving integrated care 'requires that those involved with planning, financing and providing services have a shared vision, employ a combination of processes and mechanisms, and ensure that the patient’s perspective remains a central organising principle … All legislative proposals include the full merger of NHS England and NHS Improvement, who have already started working together. These provider collaboratives are mostly at an early stage of development, and NHS England and NHS Improvement will provide further guidance in early 2021 describing a number of potential models based on some already established. With April 2021 marking the deadline for all areas in England to be part of an integrated care system (ICS), we'll be exploring the future of place and how to enhance place-based partnerships that support the continuous development of ICSs. Overview Challenge for commissioners– spend resource in way which maximises outcomes and value for money – sustainable health care system Identified ten priorities for commissioners drawing on research done by The King’s Fund and others Striking – degree to which change is called for in primary care 3. The re-organisation also raises huge questions about the role of VCSE organisations which are not addressed in this article. In addition, NHS England and NHS Improvement will create a new System Oversight Framework that will set out the expectations of ICSs and the organisations within them alongside a new Intensive Recovery Support Programme for the most challenged systems, whether on finance or quality. Patient voices need to be where they are most needed, at a local level. My wife died two months later. In light of the recent announcement to abolish Public Health England, how will these proposals align with the operating model for public health, which is being developed separately? Previously, almost all assessments of the quality of palliative care in England focused on the structure and processes of care; for example, number of staff, number of admissions, length of stay and types of services provided, 5. and they failed to routinely examine and report on outcomes for the Patient and family-centred care offers a unique opportunity to use tried and tested techniques to improve both processes of care and staff-patient interactions. Jenny Sims reports back on the key topics under discussion at this year’s King’s Fund Digital Health and Care Congress . Our initial view is set out in our accompanying blog. Looks like you’ve clipped this slide to already. Beccy Baird explains the latest form of GP collaboration. The King's Fund, February 2014. Primary care clinical leadership will be expressed at neighborhood (PCN) level, at place, and there will be a primary care perspective at ICS level. explainer looks at how these bodies are structured and the progress made before the Covid-19 (coronavirus) outbreak took hold. The King's Fund is an independent charity working to improve health and care in England. This paper considers the following approaches to funding social care for older people in England: Improving the current system flexibility over how ICSs may work together when organising specialised services. “The King's Fund, an acclaimed British health authority, has published a report on the Canterbury health system – Developing accountable care systems: Lessons from Canterbury. This includes building the digital infrastructure; connecting health and care, eg, through a shared care record; using data and digital to transform care; and developing a roadmap for citizen-centred digital channels and services. If you continue browsing the site, you agree to the use of cookies on this website. These changes included the merger of NHS England and NHS Improvement; reducing the role of competition and procurement in the NHS; a new ‘triple aim’ for all NHS organisations to improve population health, quality of care and financial sustainability; and enabling easier co-operation between NHS bodies. These place leaders will be represented on the ICS board. How will the voices and priorities of residents, service users and patients be captured and meaningfully reflected in the governance and decision-making of ICSs. While integrated care systems (ICSs) are emerging to lead on planning and commissioning care for their populations, providers are also working together to deliver integrated care… The King’s Fund and the Nuffield TrustDeveloping a National Strategy for the Promotion of Integrated Care The Evidence Base for Integrated Care Nick Goodwin and Judith Smith. In this new approach, NHS England and NHS Improvement is seeking to leave room for local discretion and flexibility, for example: However, one area where there is no flexibility is that CCGs (irrespective of any legislation) will be required to merge and become co-terminous with ICS footprints ‘before April 2022’. This explainer describes this model, sets out some of the cross-cutting themes within it and describes the associated proposals for legislative change. As briefly mentioned earlier this month, The King’s Fund in London will be previewing digital health with ‘Digital Health and Care Explained: demystifying the tech revolution in health and care”, a full day meeting on Wednesday 27 March at The King’s Fund. Primary care leaders, local authorities (including the director of public health), Healthwatch, and community and mental health services must be included in the local place partnership as a minimum, and there must be agreed joint decision-making with local government. Developing Accountable Care Systems: lessons from Canterbury New Zealand The King's Fund, August 2017 This briefing from The Kings Fund explores the development and implementation of an Accountable Care System (ACS) in Canterbury, New Zealand. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 1. These include the following. The NHS Long Term Plan has already stated that all of England will be part of an ICS by April 2021. For thirty years, policy makes in the English NHS have attempted to devise financial incentive schemes to improve the performance of health services. Remove: King's Fund source - 21 June 2018 The use of digital technology in health and social care can improve quality, efficiency and patient experience as well as supporting more integrated care and improving the health of a population. Integrated care systems (ICSs) are a key part of the NHS long-term plan, and are intended to bring about major changes in how health and care services are … Integrated care systems and place-based partnerships (virtual conference), On 7 January, the NHS long-term plan was published setting out key ambitions for the service over the. The King’s Fund have published a short paper explaining the five big issues they see for health and social care following the UK’s vote to leave the EU. Integrated care is "an organising principle for care delivery that aims to improve patient care and experience through improved coordination." We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. Helen McKenna talks with Professor Sir Chris Ham, Chief Executive of The King's Fund, about his career so far, health policy and what makes a good leader. A series of diagrams explaining how funding flows in the NHS and how providers are regulated and commissioned. As a minimum, its board would include representatives of NHS providers, primary care and local government as well as a chair, chief executive and chief financial officer. Chris Ham. Integrated care systems are made up of three major pillars of work: primary care networks, personalised care and population health management. They did however compensate me with£50 for telephone charges amounting to £13 as a result of their not answering the phone promptly. In 2021 NHS England and NHS Improvement will launch a new ‘integration index’ to support measurement of performance at system level. Integrated care systems explained: making sense of systems, places and neighbourhoods Integrated care services represent a fundamental shift in the way the health and care system is organised. The King’s Fund has published a report on “Payments and contracting for integrated care: The false promise of the self-improving health system”.. Increasingly the NHS will organise its finances on an ICS footprint, such that resources and prioritisation decisions are taken at ICS level (except where there is a pre-existing national commitment, eg, on mental health, that they must implement). This paper describes the current system of commissioning and funding general practice in England, and its shortfalls. Continuing recent trends in the financial arrangements between ICSs and providers, the NHS will continue to move away from activity-based payments (the tariff). The primary interaction between ICSs and NHS England and NHS Improvement will be through a thinner regional tier (as some functions, eg, specialised commissioning, switch to ICSs). This long read sets out the key changes for the health and care system and what their immediate, as well as potential long-term, implications might be. For most people their day-to-day health and care services will be organised at place level, where a wide range of partners will work together to meet the health and care needs of local populations. What should the NHS long-term plan say about STPs and ICSs? While all options imply changes for commissioners, CCG staff ‘who wish to play a part in the future’ will be offered opportunities for continued employment ‘up to March 2022’ as part of a package to minimise the disruption these changes would cause. Now customize the name of a clipboard to store your clips. Integrating care: next steps to building strong and effective integrated care systems across England, all of England will be part of an ICS by April 2021, engaging on these proposals with a closing date of 8 January 2021, allowing local flexibility to define the size and boundaries of places, flexibility over the exact division of roles and responsibilities between place and ICS level, flexibility over the scale and scope of provider collaboratives and their precise membership. Richard Murray reflects on the opportunities and challenges that 2019 may bring, as well as the need for. Building on existing commitments and the experience of Covid-19, there will be a continued major push to enhance data and digital capability. Our initial assessment of these changes is set out in an accompanying blog. Helen McKenna talks with Professor Sir Chris Ham, Chief Executive of The King's Fund, about his career so far, health policy and what makes a good leader. In both cases NHS England and NHS Improvement looks to build on progress already made by the NHS and its partners in working together to integrate services in the response to Covid-19. Though NHS England and NHS Improvement believes both options would support integration, it makes clear that it prefers option two. Critically, it is also where the partnerships with other sectors will be focused, including social care and public health, other local government services and the voluntary sector. NHS England and NHS Improvement suggests this should be done in a way that protects its clinical and operational independence. Chris Ham, The King’s Fund’s Chief Executive, says that integrated health care “offers the best prospect” of enabling the NHS to succeed in the future. The 15 million people in England with long term conditions have the greatest healthcare needs of the population (50% of all GP appointments and 70% of all bed days) and their treatment and care absorbs 70% of acute and primary care budgets in England.It is clear that current models of dealing with long term conditions are not sustainable. Exactly what powers will an ICS have over its constituent NHS organisations, particularly over foundation trusts? Collaboratives will be expected to agree and implement clinical pathways and reconfiguration, and to challenge and hold each other to account with open-book approaches to finance. Keywords: ('Integrated Care', 'integrated Care Pilots', 'Integration') Long Term Conditions (LTC) Electronic Templates Supporting Personalised Care Planning The Long Term Conditions Programme within NHS Yorkshire and the Humber's Programme for IT was established with the … What will the role for local government and other non-NHS partners in the ICS be, particularly in the scenario set out in option two (above), where it becomes a statutory NHS body accountable for NHS finances? Against this background, the Health Foundation and The King’s Fund are undertaking work exploring options for the future funding of social care. The King’s Fund have published a short paper explaining the five big issues they see for health and social care following the UK’s vote to leave the EU. Places are free to add further members as they wish.