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Care systems get rebrand as NHS England seeks 'next cohort'

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NHS England has rebranded accountable care systems as integrated care systems, and said they will replace sustainability and transformation partnerships, Health Service Journal reports.

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Planning guidance for 2018-19 from NHS England and NHS Improvement last week said integrated care systems (ICS) will now be the “collective term” for the devolved health and care systems in Greater Manchester and Surrey Heartlands, as well as the eight shadow accountable care systems.

It follows controversy about the term “accountable care”.

The document said that the eight shadow ICSs would not be “considered ready to go fully operational” until they produce a single system operating plan for the coming financial year. These plans should “align key assumptions on income, expenditure, activity and workforce” and system leaders within the ICS are expected to take an “active role in this process”.

It also confirmed that NHS England is still accepting bids from areas that wish to be included in the “next cohort of ICSs” and intends to have reviewed all applications by March 2018. NHS England had discussions with several areas last year about becoming part of a second wave - HSJ reported last week that the wave had been delayed from early 2018.

The planning guidance also said ICSs are expected to “involve and engage with patients and the public, [and] their democratic representatives”. The guidance makes no mention of accountable care organisations - which are the subject of two judicial reviews, a public consultation and have seen contracts delayed until 2019.

ICSs must focus on four key areas including “more robust” arrangements between STP organisations; a focus on managing population health; delivering “more care through re-designed community and home-based services”; and systems to take “collective responsibility” for financial and operational performance.

The document also laid out new regulatory oversight and financial arrangements for the eight existing shadow ICSs: 

  • NHS England and NHS Improvement will look at whether ICSs are delivering on system-wide goals. This means that ICSs will be expected to “assure and track” progress internally against organisation-level plans within their own area to ensure that they are meeting their own system wide plans.
  • Integrated care systems will “shortly” be given system control totals by NHSE and NHSI. Each region will be given the “flexibility” to vary individual control totals for each organisation and will be allowed to let some over and under perform financially as long as the system as a whole meets it overall control total.
  • In 2018-19 ICSs will be “encouraged to adopt” a full system-based approach to new funding pots called the provider sustainability fund (a renamed STF) and a new commissioner sustainability fund. This means that no payment will be made from either pot unless the whole local system has delivered its control total.  NHSE and NHSI will work with ICS leadership to decide how this income would then be allocated between local organisations.
  • Those systems that can fully integrate their finances will be given greater regulatory autonomy and ICS leadership will “play a key role” in deciding what “remedial action” will be taken if NHSI or NHSE believe they must intervene against a trust or CCG.
  • ICSs that are not ready to adopt a single control total will be offered an interim approach in which trusts in their area will be given access to existing STF funds of £1.8bn while other more developed areas will have access to a new £650m fund, as part of the new PSF approach, across all trusts. In addition individual CCGs will be able to access the new £400m CSF monies.
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