1. Good morning, I m Hardeep Jhutty from the System Transformation Group at NHS England.

Transcription

1 1. Good morning, I m Hardeep Jhutty from the System Transformation Group at NHS England. 2. I m here today to give you a national perspective on delivering system transformation for better, more sustainable care. 3. I plan to answer three main questions over the next 10 minutes or so: a. One: What are we trying to achieve, as we think about health systems in this country? b. Two: How are we trying to transform health systems, and what is the role of STPs and ACSs in enabling this transformation? c. And three: Where are we on our transformation journey and what are we practically doing at the national level, to help drive progress? So the first question what are we trying to achieve? 4. It is really important to reflect on why we are taking action at the system level before we move to the various three letter acronyms. 5. I believe what we are collectively trying to do nationally and locally is to deliver the best care we possibly can for the people living in the areas we serve ultimately to improve their health and wellbeing. 6. We believe that to do this, we need to change the way in which we deliver care the FYFV talked about triple integration between primary and secondary, physical and mental, and health and social care. 1 of 6

2 7. What does that actually mean? Well, for me it means that care is focused on what people actually need, not on what organisations can or want to provide, and that care is increasingly focused earlier in the disease journey less in the hospital, more in the community, and more targeted to prevention. 8. THAT is our ambition. That s all very well, but how are we going to achieve this? That s essentially my second question how are we transforming health systems and what is the role of STPs and ACSs in enabling this transformation? 9. Our journey started with the integrated care pioneers and more recently, continued with the New Care Models programme through which vanguards have been exploring new ways of delivering integrated care and population health approaches. 10. However, several of our challenges are systemic. We therefore need to forge partnerships that are capable of addressing system-wide problems. We believe that the next phase of this work requires us to build on the new care model programme and the work we are doing at the organisational level, and to work at the system level. 11. This is what STPs are a vehicle to allow system level collaboration, to facilitate the delivery of better care for the money we have. They are an enabler a means to an end. 12. It s important to add that they don t remove the need to work at the organisational level it will continue to make 2 of 6

3 sense to optimise processes within hospitals, for example, though a common approach across an STP isn t a bad idea. They are complementary, not an alternative to organisational accountability. 13. STPs are already strengthening cross-system working and decision making. A lot of progress has been made, and it s great to see that progress acknowledged at events like today. Most systems tell us, that system working has moved on by light years. 14. Over time, we need STPs to be more and more load bearing as well as being vehicles for collaborative conversation, they need to enable real change on the ground. 15. That brings me to Accountable Care Systems, or ACSs. What is an ACS? How would a system become an ACS? And why become an ACS? 16. Well, an ACS is an evolved version of an STP in which organisations go beyond creating systems and take on collective responsibility for managing performance, living within a system level budget, integrating services and applying validated population health management approaches. 17. Systems aspiring to become an ACS will need to demonstrate solid progress in five key areas: a. Firstly: A coherent and defined population - a meaningful geographic footprint that respects patient flows of at least around 0.5m, and providing most care for the resident population. 3 of 6

4 b. Second: A track record of delivering existing care in terms of constitutional standards and progress in delivering the FYFV next steps, thereby demonstrating that the system gets things done. c. Third: Redesign of how care is delivered a commitment to population health approaches and persuasive plans for integrating providers vertically and collaborating horizontally. d. Fourth: Strong financial management the ability to deliver control totals across the system, and system-wide plans for returning to overall financial balance. e. And finally: Effective leadership and relationships across the NHS and local government, as the bedrock of the ACS - backed by clinical engagement and shared decision-making. 18. So these are some of the things prospective ACSs will need to be able to do. But why would a system want to become an ACS? 19. Well, first, and most importantly, because we believe that it s only by working more closely together as a system that you ll be able to transform care for the people that live in your area. 20. Secondly, because taking collective responsibility means we are able to give you support, freedom and flexibilities that will enable you to go further and faster than would otherwise be the case. Key examples of this include. a. The opportunity to influence, co-produce and pilot cutting-edge policy. b. Devolved transformation funding. 4 of 6

5 c. Streamlined regulation, and a different relationship with national bodies. 21. This latter point is quite important. We are asking STPs and ACS to think and act like systems rather than individual organisations, so we accept that the way in which NHSE and I work together needs to change to reflect this too. This brings me to my third and final question: Where are we on our transformation journey and what are we doing in practice to drive progress? 22. We are running an ACS development programme we have an initial cohort of ten ACSs, including two devo areas, which we named at expo in June. 23. We have worked with the group to co-design a support package encompassing clinical and technical workstreams. 24. We re helping systems to solve problems developing solutions to the barriers and issues that we encounter. 25. Examples of key milestones we hope to achieve by the end of March are: a. to have a single system level operating plan for each ACS, that aligns activity and financial plans in a way that meets the system control total and describes how money will flow through the system using new payment approaches; and b. to have articulated learning from the first wave of ACSs in a way that can be shared to help other systems that are facing common problems 5 of 6

6 26. In parallel to supporting the current wave of ACS sites, we are currently looking to identify additional ACSs in a second wave of the programme. We expect to identify a handful of additional ACSs by January. 27. The process for selecting ACSs is led by our Regional Directors, and prospective systems will be nominated by our regions to develop an Expression of Interest that meets the five criteria that I talked through earlier. 28. For successful systems that meet the criteria, we believe that moving towards becoming an ACS is the natural next step. 29. However, systems are starting from different places and have different challenges, therefore the path towards becoming an ACS isn't linear or homogenous. We should be supporting all STPs to build on their strengths. To conclude: 30. Our ambition is to deliver the FYFV Next Steps and the best care we can for the money we have. 31. We aim to get there by working at the system level, beyond organisational silos, using STPs and ACSs as key vehicles. 32. We have launched the first wave of the ACS programme, with wave 2 to follow, and for successful STPs that meet the criteria, we believe that moving towards becoming an ACS is the natural next step. 33. Thank you. END 6 of 6