Alzheimer's Society's view on sustainability, transformation partnerships and integrated care systems’
Find out what we think about sustainability, transformation partnerships and integrated care systems.
Integrated health and social care has featured in policies across England for the past two decades (Wilson et al, 2015). This is because joined-up services have and continue to be viewed as the primary way to simultaneously reduce duplication, improve service outcomes and achieve fiscal savings (Wilson et al, 2015; Naylor et al, 2016). This is particularly pertinent in the current policy environment, with the NHS and social care system under increasing strain to meet financial and performance-related targets (Alderwick et al, 2016).
In the past three years, the movement toward integrated health and social care has evolved. In 2014, arms-length bodies for the NHS published the Five Year Forward View (NHS, 2014). This outlines three core challenges for the NHS:
1. The health and wellbeing gap
2. The care and quality gap
3. The funding and efficiency gap
The Five Year Forward View (FYFV) covers the period between 2016 and 2021. It aims to deliver new ways of working to meet the challenges outlined above and provide better outcomes for service users and communities (NHS Confederation, 2016). Following publication of the FYFV, NHS England and national partners launched the New Models of Care programme in January 2015. This aims to support delivery of the FYFV with 50 ‘Vanguard’ sites piloting joined-up working between local health and social care providers (NHS, 2015a; NHS, 2015b).
The drive toward integrated care was then further boosted in December 2015. This marked the publication of NHS planning guidance for 2016-2017, which included a requirement for local areas to develop a Sustainability and Transformation Plan to accelerate implementation of the FYFV (NHS, 2015c). 44 unique geographical areas, encompassing all of England, were tasked with developing a Sustainability and Transformation Plan to outline how local services would integrate in the next five years. Initial plans were published between October and December 2016 and are publically available (NHS, 2017a).
Following this, the Next Steps on the NHS Five Year Forward View was published in March 2017. This document states that Sustainability and Transformation Partnerships (STPs) will be the main vehicle for integrated health and care. STPs are a forum for health, social care and local government leaders to plan integrated service provision. However, STPs are not statutory bodies. Therefore, the established structure supplements rather than replaces the accountabilities of the bodies involved (NHS, 2017b). NHS England initially envisioned that STPs could become ‘Accountable Care Systems’ that would work as an integrated system at a local level (NHS, 2017b). Since then, NHS England has stated that in some areas, a Sustainability and Transformation Partnership will ‘evolve’ to form an Integrated Care System [ICS] (NHS England, 2018). An ICS is a new form of closer collaboration between NHS organisations, local councils and others, such as local charities and community groups. This involves collective responsibility for the management of resources, delivering NHS standards and improving the health of the local population (NHS England, 2018). Both STPs and ICSs are said to be drawing on the experience of the 50 ‘Vanguard’ sites (NHS, 2016a; NHS England, 2018).
Lastly, it is important to note that within the nine ‘must do’s’ in the NHS Operational Planning and Contractual Guidance: 2017-2019, is an explicit requirement for all local areas implementing the FYFV to maintain a two-thirds dementia diagnosis rate of estimated local prevalence and have due regard for NHS guidance on improving post-diagnostic care and support (NHS England and NHS Improvement, 2016).
This focus on dementia is interlinked with the sustainability and transformation process and continues to implement the Prime Minister’s Challenge on Dementia 2020 set in March 2015, which aims, by 2020, to make England the best country in the world for dementia care and support, for people with dementia, their carers and families to live and to undertake research into dementia and other neurodegenerative diseases (Department of Health, 2015).
What we call for
Currently, there are more people living with dementia than ever before. Indeed, figures indicate over 700,000 people are living with dementia in England alone (Alzheimer’s Society, 2015). Our view is that STPs and ICSs present a unique opportunity to transform dementia care and support. We know the health and social care system must evolve towards greater co-working. Indeed, this is a change we have repeatedly called for (Alzheimer’s Society, 2015). This is because integrated health and social care will facilitate a system more capable of meeting the needs of an ageing population with complex needs (Hofmarcher et al, 2007; Oliver et al, 2014; Naylor et al, 2016) and the needs of people with dementia (Alzheimer’s Society, 2015; Glimmerveen, L. & Nies, H. 2015). We also know that the complexity of dementia means an integrated system working for people with dementia will be a system that works for everyone.
We have produced a 10 point integrated dementia care plan for sustainability and transformation partnerships and integrated care systems (Alzheimer’s Society, 2018). The 10 point plan highlights the impact of dementia and lists the enablers necessary to deliver integrated dementia care. We call on all STPs and ICSs to work toward implementing the ten points outlined in our plan. You can find out more about the 10 point plan and download your own copy here.
We also call for additional funding for social care to support this activity and wider work to implement the seven principles of care outlined by the former Secretary of State for Health and Social Care, Jeremy Hunt, which includes ‘full integration of health and social care around the person’ (Department of Health and Social Care & Rt Hon Jeremy Hunt MP, 2018). We know that social care is chronically underfunded (LaingBuisson, 2017).
Our view is that inadequate social care funding threatens the delivery and sustainability of integrated services. The interdependence of the fiscal challenge between health and social care and the significant impact this will have on the successful delivery of STPs has been noted by NHS bodies and the Local Government Association (NHS Confederation, 2016). We believe short-term funding and a long-term financial commitment from Government is needed to close the social care funding gap and facilitate the achievement and sustainability of integrated services.
References and further information
1) Wilson, S., Davison, N., Clarke, M., Casebourne, J. (2015) Joining up public services around local, citizen needs: perennial challenges and insights on how to tackle them. Institute for Government. Available at https://www.instituteforgovernment.org.uk/publications/joining-up-local-services
2) Naylor, C., Das, P., Ross, S., Honeyman, M., Thompson, J., Gilburt, H. (2016) Bringing together physical and mental health: A new frontier for integrated care. The Kings Fund. Available at https://www.kingsfund.org.uk/publications/physical-and-mental-health
3) Alderwick, H., Dunn, P., McKenna, H., Walsh, N., Ham, C. (2016) Sustainability and Transformation Plans in practice: how are they being developed in practice? The Kings Fund. Available at https://www.kingsfund.org.uk/publications/stps-in-the-nhs
4) National Health Service. (2014) Five Year Forward View. Available at https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
5) National Health Service Confederation. (2016) Understanding Sustainability and Transformation Plans. Available at http://www.nhsconfed.org/resources/2016/09/understanding-sustainability-and-transformation-plans
6) National Health Service. (2015a) New Models of Care Programme. Available at https://www.england.nhs.uk/2015/01/models-of-care/
7) National Health Service. (2015b) About Models of Care. Available at https://www.england.nhs.uk/ourwork/new-care-models/vanguards/care-models/
8) National Health Service. (2015c) Delivering the Forward View: NHS Planning Guidance 2016/2017 – 2020/2021. Available at https://www.england.nhs.uk/wp-content/uploads/2015/12/planning-guid-16-17-20-21.pdf
9) National Health Service. (2016a) Frequently asked questions – STPs. Available at https://www.england.nhs.uk/stps/faqs/
10) National Health Service. (2016b) Engaging local people: A guide for local areas developing Sustainability and Transformation Plans. Available at https://www.england.nhs.uk/wp-content/uploads/2016/09/engag-local-people-stps.pdf
11) National Health Service. (2017a) View Sustainability and Transformation Plans. Available at https://www.england.nhs.uk/stps/view-stps/
12) National Health Service. (2017b) Next Steps on the NHS Five Year Forward View. Available at https://www.england.nhs.uk/wp-content/uploads/2017/03/NEXT-STEPS-ON-THE-NHS-FIVE-YEAR-FORWARD-VIEW.pdf
13) National Health Service England. (2018) Integrated care systems. Available at https://www.england.nhs.uk/integratedcare/integrated-care-systems/.
13) National Health Service England and National Health Service National Improvement. (2016) NHS Operational Planning and Contractual Guidance: 2017-2019. Available at https://www.england.nhs.uk/wp-content/uploads/2016/09/NHS-operational-planning-guidance-201617-201819.pdf
14) Department of Health. (2015) Prime Minister’s challenge on dementia 2020. Available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414344/pm-dementia2020.pdf
15) Alzheimer’s Society. (2015) Dementia 2015: Aiming higher to transform lives. Available at https://www.alzheimers.org.uk/download/downloads/id/2700/dementia_2015_aiming_higher_to_transform_lives.pdf
16) Hofmarcher, M.M., Oxley, H., Rusticelli, E. (2007) Improved Health System Performance through better Care Coordination. OECD Health Working Papers. 30. Available at http://www.oecd-ilibrary.org/social-issues-migration-health/improved-health-system-performance-through-better-care-coordination_246446201766
17) Oliver, D., Foot, C., Humphries, R. (2014) Making our health and care systems fit for an ageing population. The Kings Fund. Available at https://www.kingsfund.org.uk/publications/making-our-health-and-care-systems-fit-ageing-population
18) Glimmerveen, L. & Nies, H. (2015) Integrated community-based dementia care: the Geriant model. International Journal of Integrated Care. 15 (6). Available at http://www.ijic.org/articles/10.5334/ijic.2248/
19) Alzheimer’s Society. (2018) 10-point plan for integrated dementia care. Available at https://www.alzheimers.org.uk/dementia-professionals/resources-professionals/10-point-plan
20) Department of Health and Social Care & Rt Hon Jeremy Hunt MP. (2018) Available at https://www.gov.uk/government/speeches/we-need-to-do-better-on-social-care
21) LaingBuisson. (2017) Care home funding shortfall leaves self-funders filling £1.3 billion gap. Available at https://www.laingbuisson.com/wp-content/uploads/2017/01/LaingBuisson_Care_Cost_Benchmarks_8ed_PR.pdf