INTEGRATION and the HSCA 2012‘THE TIMES THEY ARE A CHANGIN’ Professor Bob Hudson
The ‘OLD’ PARTNERSHIP AGENDA• Joint Finance and long-stay hospital closures• Joint commissioning between PCTs and ASC• Integrated front-line teams• Health Act Flexibilities• Care Trusts ∂• Messages on ‘a good partnership’• ‘Readiness Tools’/partnership checklists• Policy exhortation• Political rhetoric
Secretary of state NHS Outcomes Framework Public Health Outcomes framework Adult Social Care Outcomes FrameworkNHSB with 4 regions and NICE 27 LATs Public CQC Health Watch EnglandMonitor Office of Fair Health Trading England Commissioning outcomes framework Local Health Watch National and Regional Specialist Commissioning Public Health 212 Health & WellbeingLocal Boards Foundation Clinical Commissioning groups ∂ Authority Trusts23 Commissioning Support Services JSNA + Joint Health and Wellbeing Strategy Independent sector Patients carers and the public 3 3
A CHANGING PARTNERSHIP LANDSCAPE• NHSCB with regional and ‘local’ outposts• Clinical Commissioning Groups• Monitor• Commissioning Support Units• ∂ Miscellaneous creations: clinical senates/networks; quality surveillance groups; NHS Commissioning Assembly; HealthWatch etc• Private companies, especially in CHS• Enduring features: acute trusts and LAs – but both in a new and evolving context
NEW ‘ARRANGEMENTS’• National Quality Standards• NHS Outcomes Framework/COF• Public Health Outcomes Framework• Public Health in Local Government• ASC Outcomes Framework ∂• Joint Strategic Needs Assessments• Joint Health and Wellbeing Boards• Joint Health and Wellbeing Strategies• Will the outcomes frameworks drive integration?• Do the JHWBs have partnering teeth?
The NEW LEGISLATIVE CONTEXT• A cornucopia of new partnership duties• Obligations on the NHS Commissioning Board• Obligations on Clinical Commissioning Groups• Obligations on Monitor ∂• Obligations on Health and Wellbeing Boards• Emerging obligations on Local Authorities in the Care and Support Bill
The NEW FISCAL CONTEXT• The ‘Nicholson Challenge’ – £20b by 2014 and beyond• LAs facing unprecedented cuts in budgets• Funding shortfall in ASC and Dilnot funding gap ∂• CHS under increasing pressure and uncertain future• Acute providers facing increased demand, tariff manipulation and threat of ‘market failure’• Will this be a lever for ‘deeper’ partnering or ‘tactical’ partnering?
The NEW IDEOLOGICAL CONTEXT• New powerful role for Monitor in ‘preventing anti- competitive behaviour’…• …and for promoting integration• Embedding of UK/EU competition law into the NHS ∂• Any Qualified Provider – first tranches well underway• How compatible are competition and collaboration?• If not easily compatible, what will the ‘trade-off’ look like?
NEW and EMERGING MODELS• Individuals as commissioners (PHBs/patient choice)• New commissioning partnerships• New provider partnerships• Year of Care funding models• ∂ Financial incentives to work jointly on ICPs• Alternative Quality Contract/Accountable Care Organisations• Moving towards HMOs?
WHERE DOES THIS ALL LEAVE INTEGRATION?• Balancing of the competitive and collaborative imperatives is unclear• Emerging evidence of ‘disintegration’ ∂• Lack of clarity over ‘system leadership’• The threat of ‘repeal’…• And replacement of HSCA by…• Yes… ‘Integration’..