Challenges of maintaining accountability in networks of health and care organisations: A study of developing STPs

Challenges of maintaining accountability in networks of health and care organisations: A study of developing Sustainability and Transformation Partnerships in the English National Health Service. Soc Sci Med. 2021 Jan;268:113512. doi: 10.1016/j.socscimed.2020.113512.

• An exploration of accountability relationships in STPs, focusing on the challenges of increasing horizontal accountability given existing vertical accountabilities, most notably to national regulators.

Improving the scrutiny of integrated care systems and sustainability and transformation partnerships: A guide to good practice

Improving the scrutiny of integrated care systems and sustainability and transformation partnerships: A guide to good practice
NHS Confederation 6 February 2020

• This guidance aims to help scrutiny leads and communications and engagement directors within ICSs and STPs to understand how they might work more effectively together to produce a relationship that works in the best interests of local partnerships and communities.

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)

Simplifying cross-sector working between NHS Integrated Care Systems, STPs and industry

Simplifying cross-sector working between NHS Integrated Care Systems, Sustainability and Transformation Partnerships and industry: Guidance on governance and process
AHSN Network and ABPI May 2019

• This document sets out a series of governance and process recommendations to enable NHS Sustainability and Transformation Partnerships and Integrated Care Systems rapidly and confidently to develop collaborations with industry partners to address local health needs.

STPs in London - a review of progress

Sustainability and transformation partnerships in London
Kings Fund 16 October 2018

• A review of the progress made over the past year by the capital’s five STPs finds evidence of improvements in services for patients in boroughs and neighbourhoods across London which are often supported by the partnerships, but that London’s STPs are less advanced than those in many other parts of England.
• London’s STP leaders have spent much of their time over the past 12 months focusing on the internal workings of the partnerships, building relationships with their partners and addressing gaps in staff and public engagement.

NICE Resources for STPs and ICSs

Resources for STPs and ICSs
NICE

• A collection of NICE resources (based on guidance, quality standards, advice and practical tools) which will help systems work in partnership to provide consistent, high-quality care, based on the best evidence to support STPs and ICSs. Topics include 
• Prioritisation, 
• CVD prevention: detecting atrial fibrillation and anticoagulation
• CVD prevention: preventing, detecting and managing diabetes
• Improving care and support for people with frailty
• Improving transfer of care
• Making Every Contact Count
• Medicines optimisation 
• Transforming urgent and emergency care
• Putting our guidance into practice

Key questions for the future of STPs and ICSs

Key questions for the future of STPs and ICSs
NHS Providers August 2018

• This briefing summarises recent developments relevant to system working, sets out the state of play for STPs and integrated care systems and seeks to offer answers to a number of questions arising from the national policy focus on collaboration and integration.

Sustainability and transformation in the NHS - PAC committee report and Liaison Committee

Sustainability and transformation in the NHS
House of Commons Public Accounts Committee 27 March 2018

• The latest report from the HC PAC describes an NHS "still in survival mode", using capital budget to fund short term needs rather than long term transformation. 
• The Department have been asked to report back to the Committee on a number of issues: 
• progress towards more stable long-term funding arrangements, 
• action to tackle workforce issues, a strategy for addressing long-term structural problems in trusts, 
• a review of how capital budgets are spent, outlining model guidance articulating how accountability will work under the new integrated care systems
• guidance and evidence of how the NHS, local government and the voluntary sector can work more cohesively as a whole system, including communication and engagement with patients and 
• work to promote new ways of working and examples of good practice by vanguards to all areas of the country.
• Speaking at the Liaison committee on Tuesday (listen from 17.51) the Prime Minister's comments very much reflects findings with the announcement of a new “sustainable long term plan” for the NHS based on “genuine cross party engagement” (but not a public commission).

PAC report Summary

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.

Integrated Care Systems - Refreshing NHS Plans for 2018/19

Refreshing NHS Plans for 2018/19
NHS England 2 February 2018

• This guidance builds on guidance set for 2017/19 to enable organisations to continue to work together through STPs to develop system-wide plans that reconcile and explain how providers and commissioners will collaborate to improve services and manage within their collective budgets. The guidance outlines "additional freedoms and flexibilities" which will support the most advanced Integrated Care Systems to lead this process.
• NHS England are now using the term ‘Integrated Care System’ as a collective term for both devolved health and care systems and for those areas previously designated as ‘shadow accountable care systems’. An Integrated Care System is where health and care organisations voluntarily come together to provide integrated services for a defined population. (page12)
• The guidance is accompanied by revised clinical commissioning group allocations for 2018/19.

Extract from p12:
4 We see Integrated Care Systems as key to sustainable improvements in health and care by:
• creating more robust cross-organisational arrangements to tackle the systemic challenges facing the NHS;
• supporting population health management approaches that facilitate the integration of services focused on populations that are at risk of developing acute illness and hospitalisation;
• delivering more care through re-designed community-based and homebased services, including in partnership with social care, the voluntary and community sector; and
• allowing systems to take collective responsibility for financial and operational performance and health outcomes.

Technical Guidance for Refreshing NHS Plans 2018/19

NHS England 23 February 2018

Making sense of Integrated Care Systems

Making sense of Integrated Care Systems
Chris Ham, Kings Fund 20 February 2018

• In its refreshed NHS Plans for 2018/19  NHS England has changed the name of accountable care systems (ACSs) to integrated care systems (ICSs). In this "long read" Chris Ham looks at the work under way and explains the terminology. 

Improving Clinical Communications Between Primary and Secondary Care Clinicians

Improving Clinical Communications Between Primary and Secondary Care Clinicians: A review and recommendations for the Sussex and East Surrey STP
South East Clinical Senate,  10 January 2018

• This review looks at the current barriers and enablers to better clinical communications, reviews some of the pertinent literature, single centre experiences, and technologies that have been used, and provides a range of recommendations for how this agenda can be taken forward.
• Recommendations include
• Improving telephone communications - Enabling GP contact with specialists
• Enhancing secondary care access to GPs
• Use of Video links
• Shared access to Integrated Digital Care Records 
• Fostering improved relationships between GPs and consultant
• Contractual incentives and levers to support and encourage improvement In clinical communications.

Additional funding used to cope with existing pressures - NAO

Sustainability and transformation in the NHS

National Audit Office 19 January 2018

• According to NAO analysis, additional funding aimed to help the NHS get on a financially sustainable footing, has instead been spent on coping with existing pressures.
• The NAO has made a number of recommendations to the Department, NHS England and NHS Improvement, which includes moving further and faster towards aligning nationwide incentives, regulation and processes, as well as reassessing how best to allocate the sustainability and transformation funding.

Sustainability and Transformation Fund spent on coping with existing pressures

Sustainability and transformation in the NHS
National Audit Office 19 January 2018

• According to NAO analysis, the Sustainability and Transformation Fund which was intended to help the NHS get on a financially sustainable footing, has instead been spent on coping with existing pressures. 
• The NAO has made a number of recommendations which includes moving further and faster towards aligning nationwide incentives, regulation and processes, as well as reassessing how best to allocate the sustainability and transformation funding.

Autumn Budget 2017 and the NHS

Two HM Treasury documents outlining the impact of the budget on the NHS.

Autumn Budget 2017: NHS spending
HM Treasury 23 November 2017

• The Autumn Budget 2017 included £6.3 billion of new funding for the NHS in England, including £2.8 billion over the next three years for day-to-day services and £3.5 billion of capital investment by 2022/23. This document sets out the background to NHS spending including the impact of the budget announcement.

Funding for local groups of NHS organisations (Sustainability and Transformation Partnerships)

HM Treasury 23 November 2017

• This document sets out the first twelve schemes due to benefit from government investment in local groups of NHS organisations (Sustainability and Transformation Partnerships) to deliver transformation schemes and improve their ability to meet demand for local services.
• Sustainability and Transformation Partnership bids selected for the first wave of provisional funding
• Barnsley Hospital Children’s Emergency Department and Assessment Unit scheme (South Yorkshire and Bassetlaw STP)
• Doncaster Urgent and Emergency Care scheme (South Yorkshire and Bassetlaw STP)
•  Leeds Community Child and Adolescent Mental Health Inpatient Unit scheme (West Yorkshire STP)
• Chesterfield Urgent Care scheme (Derbyshire STP)
• Russell’s Hall Hospital Dudley Urgent Care Centre scheme (Black Country STP)
• Birmingham Children’s Hospital Emergency Department scheme (Birmingham and Solihull STP)
• South Warwickshire NHS Foundation Trust Out of Hospital Care scheme (Coventry and Warwickshire STP)
• Mid and South Essex Acute Hospitals reconfiguration scheme (Mid-and-South Essex STP)
• South West London and St George’s NHS Mental Health Trust Estates Modernisation scheme (South West London STP)
• Frimley Out of Hospital Integrated Care Hubs scheme (Frimley Health STP)
• Bracknell Forest Heathlands scheme (Frimley Health STP)
• Chiltern and Aylesbury Vale Primary Care Hub scheme (Buckinghamshire, Oxfordshire and Berkshire West STP)

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.

System Transformation and Care Homes: A discussion document

System Transformation and Care Homes: A discussion document
Good Governance Institute and Care England October 2017

• A discussion paper, developed through a literature review and desktop review of all 44 STPs, identifies the gaps in the STP process and how care homes can fill these gaps. Opportunities are illustrated through case studies from three of the vanguard sites – Airedale and Partners, Gateshead Care Home Project and Sutton Homes of Care

STPs - developing robust governance arrangements

Sustainability and transformation partnerships: developing robust governance arrangements
HFMA 11 October 2017

• The HFMA’s Governance and audit Committee has developed a diagnostic tool which on completion, can underpin STP board/ governing body/ audit committee discussions by highlighting where robust arrangements are already in place and also where more work is required.

STPs the background and debate

Sustainability and transformation plans and partnerships
House of Commons Library briefing 29 September 2017

• This House of Commons Library briefing explores how Sustainability and Transformation Plans were developed, as well as research and debate surrounding the content and implementation of these plans.