NHS moves to end “fractured” care system

The head of NHS England will today (Thursday 15 June) pledge to end the “fractured” health and social care system that leaves too many patients “passed from pillar to post” by giving local leaders and communities more control over how they improve health and social care.

Addressing the NHS Confederation in Liverpool, Simon Stevens said: “As the NHS approaches its 70th Birthday, we are now embarked on the biggest national move to integrating care of any major western country. For patients this means better joined up services in place of what has often been a fragmented system that passes people from pillar to post.”

He announced nine areas in England – covering some seven million people – which will be the forefront of nationwide action to provide joined up, better coordinated care breaking down the barriers between GPs and hospitals, physical and mental healthcare, social care and the NHS.

Eight ‘accountable care systems’ (ACSs) will bring together local NHS organisations, often in partnership with social care services and the voluntary sector. They build on the learning from and early results of NHS England’s new care model ‘vanguards’, which are slowing emergency hospitalisations growth by up to two thirds compared with other less integrated parts of the country.

The first group of designated ACSs have agreed with national leaders to deliver fast track improvements set out in Next Steps on the Five Year Forward View, including taking the strain off A&E, investing in general practice making it easier to get a GP appointment, and improving access to high quality cancer and mental health services.

These areas will also lead the way in taking more control over funding available to support transformation programmes – with the combined indicative potential to control around £450m of funding over the next four years – matched by accountability for improving the health and wellbeing of the populations they cover. NHS national bodies will provide these areas with more freedom to make decisions over how the health system in their area operates.

The announcement also includes a new devolution agreement in Surrey Heartlands, similar to the existing one in Greater Manchester. This agreement will bring together the NHS locally with Surrey County Council to integrate health and social care services and give local leaders and clinicians more control over services and funding.

The eight accountable care systems are:

  • Frimley Health including Slough, Surrey Heath and Aldershot
  • South Yorkshire & Bassetlaw, covering Barnsley, Bassetlew, Doncaster, Rotherham, and Sheffield
  • Nottinghamshire, with an early focus on Greater Nottingham and Rushcliffe
  • Blackpool & Fylde Coast with the potential to spread to other parts of the Lancashire and South Cumbria at a later stage
  • Dorset
  • Luton, with Milton Keynes and Bedfordshire
  • Berkshire West, covering Reading, Newbury and Wokingham
  • Buckinghamshire

In addition, it is expected that West, North and East Cumbria and Northumberland could join the group of accountable care systems later in the year.

The announcement came as NHS England Medical Director Professor Sir Bruce Keogh told the conference: “We need to heal fractures between services and tear down those administrative, financial, philosophical and practical barriers to the kinds of services our patients want us to deliver.  To get there, we must replace the fear of change with convincing arguments for the future – or I for one worry that risk weakening our greatest social asset through inaction or fatigue.”

Helping to explain what integrated care means for patients and staff, the NHS today released a web film in which Jennifer Eaton from Weymouth, whose partner Denis has pulmonary fibrosis, describes its impact. She says: “Immediately things started to improve and we feel as if people care now – and we have help.”

Dr Karen Kirkham, a GP and clinical leader in Dorset, said: “I couldn’t and wouldn’t go back to what we had before. The teams were completely separate. Health teams completely separate from social care teams – and that meant that nobody talked to each other and nobody joined up care, but also that there was no collaborative working really at all within the system.”

Tom Gentry from Age UK says: “Integrated care is more than just a buzz word – it’s a way of working. It’s how the NHS should operate because when you are dealing with people with long-term conditions, multiple long-term conditions, old people with frailty, they cannot afford the service to be disjointed.”