Accountable Care-Welcome to Sheffield Save Our NHS
In 2016 we learnt that England had been divided into 44 areas called "footprints" and that ours was South Yorkshire and Bassetlaw. Sustainability in this context means financial viability, with cuts of £571 million over 4 years, while transformation means keeping people out of hospital, supposedly developing more local community-based care, but without the necessary funds. The STP covered 5 "Places" - Barnsley, Bassetlaw, Doncaster, Rotherham and Sheffield, and each was to have a Place plan.
Accountable Care was already mentioned in the STP, as the general aim of the whole exercise, the ACS being described as a possible alliance or network of providers. The ACO is the final aim, as there is one contract for the whole area. Like other contracts, any qualified provider will be able to bid, including private companies. but can you tell the difference here between ACO and ACS?
"What is an Accountable Care System (ACS)?
An accountable care system takes accountability for the delivery of care and care outcomes for a defined population and geography within an agreed budget. In doing so it designs and delivers services to best meet the needs of its population and improve health and
wellbeing outcomes. Accountable care systems take many different forms, ranging from fully integrated systems to looser alliances and networks of hospitals, medical groups, and other providers.
What is an Accountable Care Organisation (ACO)?
An ACO is a group of providers, under one contract with a commissioner, which has accountability for all care and outcomes for a populatin for an agreed period of time.
An ACO may take on a variety of orgnaisational forms. However, typically it is expected that in order for an ACO to be truly "accountable" for the delivery of both quality and cost outcomes, they need to work to a minimum population size of at leasdt 10,000 patients and operate as a distinct legal entity. Population focus may be defined by a number of factors including geography, patient profiling, disease groups or age. There are ACO models developing nationally, and internationally." [taken from SYB STP.]
What is an Accountable Care System (ACS)?
In March 2017, a list of STP areas was given, including ours, South Yorkshire and Bassetlaw, which were to move more quickly towards developing Accountable Care Systems.
On 23 June, Andrew Cash, ACS Lead sent a document called Memorandum of Understanding - 'Agreement' to all the South Yorkshire and Bassetlaw Accountable Care System Chief Executives, describing them as parties to the agreement and urging them to 'seek support for the direction of travel with your board, governing
body and council meetings by the end of July.' The document makes it clear that the main parties to the agreement are NHS bodies, while elected Councils are just partners in, expected to support NHS decisions - so much for Scrutiny powers and the decision of Labour Conference in 2017 to oppose all this costly reorganisation, whatever it is called STPs or ACSs.
You can read the full Memorandum document here.
Curiously, for people confused by the jargon, it says:
"As we are in transition it is helpful to clarify how we are using terminology and acronyms for the
purposes of this document. Sustainability and Transformation Plan (STP), Accountable Care System
(ACS) and South Yorkshire and Bassetlaw Health and Care Partnership (SYB) are used throughout and
they refer to the same thing – our SYB Partnership and our collaborative approach." It is clear that the aim was to move to a full-blown ACS by 2018/19. However, there has been yet another rebranding: now it's the South Yorkshire and Bassetlaw Integrated Care System!
What are they actually doing in SYB?
Hospital Services Review to decide which local services to close and centralise. These are the services being considered:
Commissioning for Outcomes to restrict treatments to patients who meet certain criteria.
Pushing ahead with limited consultation and public involvement, and inadequate Council Scrutiny.
For a "beginners' guide" try this video from the Kings Fund. For more critical approaches try the Keep Our NHS Public website, including their resource cabinet.
Labour Conference voted in 2017 to oppose STPs and ACOs in a resolution called composite 8, posted here.
JR4NHS mounted a legal challenge - fighting "to get proper consultation, parliamentary scrutiny and respect for the law. Save our NHS from an American-style take-over." Read lots more on their Twitter and Facebook pages.
999 call for NHS are also challenging ACOs:
"Our case is based on our deep concern that the Accountable Care Organisation contract is not only unlawful under current NHS legislation - but would lead to restrictions and denial of NHS care, and the abandonment of the core NHS principle of providing comprehensive care to all who have a clinical need for it, free at the point of use. It would replace this with health insurance company principles, based on assessments of financial risk and returns." LINK.
Barnsley Save Our NHS unsuccessfully took the Joint Clinical Commissioning Group to court to challenge their decision to close hyperacute stroke services in Barnsley and Rotherham. Details here.
There have also been Tory challenges! Even Sarah Wollaston MP asked Jeremy Hunt to slow down: see her letter here.
Excellent work by Keep Our NHS Public and others responding to the House of Commons Select Committee is here: text and video. Among other points, they argue that integrated care does not require all the costly reorganisation of the NHS.