Western healthcare systems face a perfect storm of rising demand and rising costs, and in an insightful new white paper, Deloitte have unpicked some of the detail behind the NHS’s response – the shift to a more integrated model of care provision.
Proactive Health Management
The UK’s healthcare system faces a series of complex challenges. With a growing and ageing population, the pressure on service providers continues to rise, yet budgetary constraints mean that our population’s demands can be met only through the use of increasingly innovative solutions. And while rapid technological advance has driven improvements in both the efficiency and the effectiveness of many therapies, the NHS Long Term Plan clearly recognises that if we are to find a sustainable solution, this will involve a fundamental shift away from reactive care, towards proactive population health management (PHM)
When NHS England published its Five Year Forward View back in 2014, it focussed on three core areas: health and wellbeing, care and quality, and finance and efficiency. Faced with major challenges across the board, senior NHS leaders highlighted the urgent need for an integrated approach, and their response was to select 50 NHS ‘vanguard’ regions which would roll out a new integrated model of care. However, progress was undermined by a series of pre-existing governance and legal complications, and the success of individual regions has largely been dependent on the strength of the management structures in place.
The shift to integrated care
In response to disappointing early results, in 2018 a small number of Sustainability and Transformation Partnerships were designated as Integrated Care Systems (ICSs), with the aim of bringing together primary, secondary and community care services to collaborate with local authorities and other stakeholders and service providers. Within each ICS, accountability for intelligently managing resources, achieving NHS standards and improving the population’s health and wellbeing is shared – helping to ensure that all partners pull in the same direction with a common goal. By the close of 2018, NHS England had succeeded in setting up 14 ICSs across the country.
The way forward
There are, of course, many hurdles to overcome along the road to delivering a truly integrated healthcare model, not least of which is the legislative paradox that promotes competition between providers (as per The Health and Social Care Act 2012), yet also requires health and social care organisations to operate as one of 44 regionally-based Sustainability and Transformation Programmes (as per the 2016 NHS England directive). This forces providers to perform a balancing act between fulfilling their role as competitive organisations driven by market forces, and playing a collaborative role in helping the wider Programme achieve its defined objectives. The diverse organisations that make up these STPs have different accountabilities and funding models, so if greater integration of services is to be achieved quickly, aligning the interests of service providers will perhaps be the greatest challenge of all.
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