The way in which STPs and ACSs are implemented will make the difference between them succeeding or failing, writes David Hare
The conveyer belt of NHS acronyms may have been moving more quickly in recent months, with STPs (formerly sustainability and transformation plans) becoming sustainability and transformation partnerships, while accountable care systems (ACSs) emerging as a more approachable alternative to their forerunner, the accountable care organisations.
At the heart of each of these acronyms is a new way of delivering NHS care – and on the eve of the NHS’s 70th birthday, their success will be an important factor in determining how the NHS shapes up for the years ahead.
At their core, ACSs help providers and commissioners better assess the populations they serve, and creating different care strategies based on each group’s needs. Through focusing on more preventative care, this should improve outcomes and also help reduce emergency admissions and constrain costs.
It is clear that STPs and ACSs still have political backing, with the important symbolism of the health secretary and his senior ministerial team joining NHS England boss Simon Stevens at a recent King’s Fund event to talk about progress to date. But what is also clear is that the pressure is now on to deliver results, and it is here that the importance of looking outwards beyond the usual suspects around the table becomes important.
Firstly, it is important for system leaders to ensure they are talking with as many existing providers on their patch as possible, including the independent and third sectors. In the independent sector alone there are tens of thousands of health and care staff treating NHS patients across the country, and there is also considerable capability in the voluntary and social enterprise sectors.
Local systems should be asking themselves what they don’t know and whether they can bring in support and expertise from outside to help
Knowing who these organisations are and establishing strong connections with their leadership teams will be critical to the effective delivery of ACSs in every part of the country.
Secondly, local systems should be asking themselves what they don’t know and whether they can bring in support and expertise from outside to help. Rooting system planning in a sense of place has always had merit but the big danger with it is that the local system stagnates, resulting in local leaders sitting in airless rooms asking the same questions (and getting the same answers) as they have done for decades.
The message can and should be sent out from the national NHS bodies – from CEOs down – that it is OK to talk to partners outside of the public sector
Local leaders need to challenge themselves over the gaps they identify in capital, capacity and capability in their area and seek to fill them. Indeed, rules and regulations may actually help here, making best use of processes such as “competitive dialogue” to bring in new operators from outside the system to help shape what is needed and improve overall service design.
Thirdly, the message can and should be sent out from the national NHS bodies – from CEOs down – that it is OK to talk to partners outside of the public sector. It is still often the case that the independent sector – which represents £9 billion of NHS spend excluding general practice, community pharmacy and NHS dentistry – is dropped into the “other” category when partnerships are being encouraged.
Being clear that engaging local independent sector partners in ACSs, treating them as part of the local system and reaching out to independent sector players who are doing interesting work elsewhere which could be replicated in a particular ACS is entirely sensible and one of the ways that ACSs will deliver success.
The potential of ACSs to change the way NHS funded services are delivered is considerable and given the success similar models have had internationally, it is a journey worth embarking upon. But the way in which they are implemented will make the difference between them succeeding or failing.
If STPs and ACSs are going to deliver realisable change for the populations they serve, it is important for those leading them to reach out beyond the comfortable status quo and, with national support, to forge new partnerships and relationships.