Health Systems Support Framework (HSSF)

Health Systems Support Framework (formerly ACS & STP Development Partner Framework)

HSSF Refresh

• NHS England are looking to re-procure some of the services within the Health Systems Support Framework to allow for updates to its scope and to give new suppliers an opportunity to bid.
• Refresh tender documents published 14/11/2019 (deadline 16 December 2019) available here.

ACS & STP Development Partner Framework [aka LPF2]

NHS England, 15 December 2017
First tender documents here

• Tenders are open for suppliers to register to take part in the forthcoming the ACS & STP Development Partner Framework which will give commissioners and providers access to Population Health Management support. 
• This includes tools to identify patients who are at high risk of an adverse event and are likely to be amendable to a particular intervention, patient records that give clinicians across all care settings a full picture of their patient’s health and well-being; support to monitor wider system programmes; and enhanced tools to integrate clinical workflow with patient activation data to ensure patients are being treated in the right place at the right time.
• The ACS and STP Development Partner Framework will be structured around three areas:
• Infrastructure: encompassing EPR and place-based digitalisation; Local Integrated Care Records and Health Information Exchange; primary care IT support and transformation; and data management and information governance;
• Insight: population health analytics and digital tools for system modelling, planning, risk stratification and impactability, care coordination and care management.
• Impact and Intervention: transformation and change; primary care transformation; self-care, patient empowerment and activation; and system optimisation.
• Tender documents available on the NHS England e-tendering site here.

Framework renamed Health Systems Support Framework (2 February 2018)

Integrated care: organisations, partnerships and systems inquiry

Integrated care: organisations, partnerships and systems inquiry
Health Select Committee ongoing

• An inquiry into Sustainability and Transformation Partnerships (STPs), Accountable Care Systems (ACSs) and Accountable Care Organisations (ACOs). 
• Evidence (oral and written) from NHS Confederation, NHS England and others available here.

Making sense of integrated care systems, integrated care partnerships and accountable care organisations

Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England.
Kings Fund 20 February 2018

• NHS England has recently changed the name of accountable care systems to integrated care systems, which describes more accurately the work being done in the 10 areas of England operating in this way. Our updated long read looks at work under way in these systems and at NHS England’s proposals for an accountable care organisation contract.

Accountable Care reading list from Kings Fund

Accountable care - reading list
Kings Fund - ongoing

• A selected list of references held by the Kings Fund library.

A two-way street What can CCGs teach us about accountability in STPs?

A two-way street What can CCGs teach us about accountability in STPs?
Nuffield Trust 15 November 2017

• Analysis and insights from interviews by senior CCG leaders and NHS England policy-makers, and discussions at learning networks on the current processes to hold both providers and commissioners of NHS services to account, and considers the implications of this learning for the future development of STPs, accountable care organisations and accountable care systems.

An eight step guide to accountable care

Accountable care – the art of the possible An eight step guide to accountable care
NHS Providers, Aldwych Partners, Hempsons 7 November 2017

• Update a of a previous report which suggests eight steps  by which NHS provider organisations might respond to proposals for the evolution of STPs into Accountable Care Systems (ACSs) and in some areas eventually into Accountable Care Organisations (ACOs). 
• The eight steps are Phasing, Partners, Governance, Contracting, Funding, Organisational form, Enablers and Competition.

Steering towards strategic commissioning: Transforming the system

Steering towards strategic commissioning: Transforming the system
NHS Clinical Commissioners 27 September 2017

• Analysis, informed by a survey and interviews with CCG leaders, setting out CCGs’ vision for the future and what they need to get there at pace so they can deliver more for patients.
• The four main ways in which the landscape is developing are:
• CCGs operating across larger footprints as strategic health commissioners using STPs as a key vehicle for delivery;
• integration of healthcare commissioning with local authorities;
• developing an accountable care system;
• developing integrated delivery models such as accountable care organisations.

ACSs and ACOs - what are they?

Accountable care systems and accountable care organisations - BMJ Briefing
BMJ 2017;358:j4105, 4 September 2017

• A very short briefing by Tom Moberly, UK editor, The BMJ, including history and how they might affect the NHS and what the critics say.

(Full text available through NHS OpenAthens: Register here https://openathens.nice.org.uk )

Developing accountable care systems: lessons from Canterbury, New Zealand

Developing accountable care systems: lessons from Canterbury, New Zealand
Kings Fund, 24 August 2017

• Useful lessons for the NHS from the transformation of health care in Canterbury, New Zealand over the past 10 years. These changes were achieved through developing a number of new delivery models, which involve better integration of care across organisational and service boundaries, increased investment in community-based services, and strengthening primary care.
• Models implemented in Canterbury include:
• HealthPathways – primary care management and referral pathways 
• the acute demand management system 
• the electronic shared care record view 

Accountable care organisations (ACOs) explained

Accountable care organisations explained
Kings Fund 14 June 2017

• NHS England has recently outlined ambitions for STPs to evolve into ‘accountable care systems’ (ACSs), and proposed that these ACSs might become accountable care organisations (ACOs) but only after ‘several years’. This page presents a brief overview of ACOs.

Resources for STPs and accountable care systems

Resources for sustainability and transformation partnerships (STPs) and accountable care systems (ACSs)
NHS England

• A range of information, commentary and tools that help to demonstrate the opportunity and challenges within the NHS – and for local teams to use as they develop their plans for change including:
• External reports and information
• NHS in the news
• Engaging local people – a guide for local areas developing sustainability and transformation plans
• Updates from Simon Stevens and Jim Mackey
• Indicative STP allocations
• Quick guides - what success in 2020 would look like, and suggestions about how areas could approach implementation.

Leading across the health and care system

Leading across the health and care system
Kings Fund 9 May 2017

• As the NHS seeks to move away from competition towards integration and to develop new models of care, individuals and organisations across the health and care system need to learn to work together to make the best use of collective skills and knowledge.
• This paper offers those who are leading new systems of care some guidance on how to address the challenges they face. It draws on the Fund’s work on the development of new care models, sustainability and transformation plans, and accountable care organisations. 
• The paper details five factors that facilitate system leadership:
• develop a shared vision and purpose
• have frequent personal contact
• surface and resolve conflicts
• behave altruistically towards each other
• commit to working together for the longer term

Next Steps on the Five Year Forward View - Accountable Care Systems

Next Steps on the Five Year Forward View - Accountable Care Systems
NHS England 31 march 2017

• "ACSs will be an ‘evolved’ version of an STP that is working as a locally integrated health system. They are systems in which NHS organisations (both commissioners and providers), often in partnership with local authorities, choose to take on clear collective responsibility for resources and population health. They provide joined up, better coordinated care."
• ACSs are STPs – or groups of organisations within an STP sub-area – that can:
• choose to take on clear collective responsibility for resources and population health to provide joined up, better coordinated care.
• together manage funding for their defined population,
• create an effective collective decision making and governance structure,
• operate on a horizontally integrated basis
• also operate as a vertically integrated care system, partnering with local GP practices formed into clinical hubs serving 30,000-50,000 populations.
• deploy rigorous and validated population health management capabilities 
• establish clear mechanisms by which residents will still be able to exercise patient choice 
• In Q1 2017/18, NHS England and NHS Improvement will jointly run a light-touch process to encourage other STPs (or coherent parts of STPs) to come forward as potential ACSs and to confirm this list. Likely candidates include:
• Frimley Health
• Greater Manchester
• South Yorkshire & Bassetlaw
• Northumberland
• Nottinghamshire, with an early focus on Greater Nottingham and the southern part of the STP
• Blackpool & Fylde Coast, with the potential to spread to other parts of the Lancashire and South Cumbria STP at a later stage.
• Dorset
• Luton, with Milton Keynes and Bedfordshire
• West Berkshire
• Some ACSs may lead to the establishment of an accountable care organisation (ACO) where the commissioners in that area have a contract with a single organisation for the great majority of health and care services and for population health in the area. 

Greater Nottingham Accountable Care System

Greater Nottingham: Accountable Care System
Presentation by Stephen Shortt given at Mainstreaming primary and acute care systems and multispecialty community providers: Sharing the learning, Kings Fund 21 March 2017

• A description of the origins, Actuarial Analysis, ACS Framework and model