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Council 'at breaking point' over NHS push to accountable care system

Allison Coggan
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Leicester City Council has threatened to raise formal concerns with Leicester, Leicestershire and Rutland STP over proposals to evolve into an accountable care system, HSJ has learned.

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A paper entitled Moving Towards Accountable Care in LLR was presented to the board of University Hospitals of Leicester Trust last week, which said “this is not about ‘whether’ an ACS [is established] but ‘when’.”

However, the three local authorities have criticised the absence of detailed plans to tackle the £399m financial gap outlined in the sustainability and transformation plan, and the failure to establish accountability and governance frameworks.

There is also concern over the performance of the acute trust, which has been ordered to improve by NHS Improvement after some of the worst A&E performance in the country.

Rory Palmer (Lab), deputy city mayor of Leicester City Council, who also chairs its health and wellbeing board, said: “Our patience is being tested to breaking point. It is likely our very serious concern will be formalised. It is likely we will be contemplating whether it is right for our officers and teams to remain engaged with the programme.”

NHS organisations are considering the ACS proposals were being considered after system leaders in the STP, which is rated “advanced”, met with NHS England and NHS Improvement.

However, Cllr Palmer said he had been involved in “zero discussions”, which fuelled suspicions that plans were being “cooked up behind closed doors away from public scrutiny”.

He accepted council officers had been engaged in the STP because of the “critical interface” between health and social care but said there had been no consultation over the ACS proposals with “decision makers”.

“[The ACS plans] have been nowhere near any health and wellbeing board or health scrutiny committee and that is leading to suspicion about what is behind this and driving it. It is multiplying a lot of the scepticism and concern about the STP,” he said.

John Sinnott, chief executive of Leicestershire CC, said the councils had not agreed to consider ACS proposals.

“At this stage, a lot more work is needed on the STP before it goes to consultation in 2018 and on the ACS concept, where the NHS bodies need to come to their own agreed position before involving the local authorities,” he said.

Richard Clifton (Con), a cabinet member and chair of Rutland health and wellbeing board, said Rutland CC shared the concerns.

He said: “We need an STP we would all be comfortable with and I think we are a long way from that.

“The concept is right, as far as having a plan for the future that looks forward five years and gets a sustainable basis for health and social care services. Everyone buys into that and it makes absolute sense. It’s just that what we have at the moment isn’t getting us to where we need to be.”

An STP spokesperson said the partnership had secured £40m in capital investment following the spring budget.

She said: “Nonetheless, the plan is still being developed and there are some challenging issues around capacity and demand still to resolve.

“Most recently, we have been talking about how we might create an organisational and contracting structure that makes the development of new services and new clinical pathways easier.

“Inevitably, those discussions will take time, not least because each partner starts from a slightly different place and each have their own challenges, but the system leadership team remain focused on our overall aim of creating a sustainable health and social care system for local people.”

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