Three Sustainability and Transformation Partnerships in North Cumbria and the North East have been amalgamated into the massive new Cumbria and North East Integrated Care System
Cumbria and North East Integrated Care System is due to go live in March 2019 as one of the 3rd wave of Integrated Care Systems.
(The others are South East London, Devon, Bristol, Norfolk and Buckinghamshire Oxfordshire and Berkshire West – where the development of the BOB STP into an Integrated Care System is being “supported by experts from PWC and Optum.”)
The NHS Long Term Plan says the whole of the country will be covered by ICSs by April 2021
The huge North Cumbria and North East Integrated Care System will have 4 Integrated Care Partnerships – North, South, East and West.
An Integrated Care Partnership is an alliance of providers and commissioners. Some Integrated Care Partnerships have providers carrying out commissioning functions, as subcontracting arrangements are put in place between lead providers and their partners.
The Northumberland Accountable Care Organisation that was stalled last year has come back as the North Integrated Care Partnership. This revenant is led by Jim Mackey – a qualified accountant who was formerly boss of NHS Improvement, while he was the seconded head of the Northumbria Healthcare NHS Foundation Trust.
Last year North Tyneside Council put it on record that they were not happy about the idea of being a “partner” in a North Integration Partnership.
On 28.3.18 the Council voted unanimously that
“This council agrees that there is a growing body of evidence questioning the wisdom of …Accountable Care Organisations / Integrated Care Systems…This Council agrees to oppose any proposal to implement the delivery of healthcare in North Tyneside via an Accountable Care Organisation / Integrated Care System, a project which in North Tyneside CCGs own report was stated to be high risk”.
It’s not clear what form North Tyneside Council’s opposition to the Integrated Care System has taken since they passed the motion. The ‘Four Integrated Care Partnerships’ graphic shows that the Council is a partner in the North Integrated Care Partnership, along with Northumberland, Newcastle and Gateshead Councils.
By April 2021, each Integrated Care System is to make a single set of commissioning decisions at system level
According to North East London Commissioning Support Unit – one of the organisations on NHS England’s Health Services Support Framework, which lists approved suppliers for setting up integrated care systems:
“The Operating Plan guidance and the Long Term Plan both make reference to commissioning arrangements that will need to be in place to underpin delivery of integrated care. The ambition is that by April 2021 every Integrated Care System (ICS) has streamlined commissioning arrangements that enable a single set of commissioning decisions at system level. This will be supported by NHS England and NHS Improvement, taking a more proactive role in supporting collaborative approaches between trusts.”http://www.nelcsu.nhs.uk/nel-delivers-on-ics-contracting-and-procurement-support/
It seems that all the Integrated Care Systems in waves 1-3 are to use capitated budgets
The capitated payment method involves NHS commissioners paying a fixed annual amount for a whole range of NHS services for an area’s population, instead of paying for each patient’s treatment.
It is the subject of 999 Call for the NHS’s ongoing legal challenge to the contentious new Integrated Care Provider contract – formerly known as the Accountable Care Organisation contract before NHS England rebranded it.
Health campaigners believe that this payment method carries a big risk that there would not be enough money in such contracts to cover the costs of providing high quality treatments to all patients who have a clinical need for them.
It turns out that this payment method is to be used in a range of new “service and payment models” for integrated care that Clinical Commissioning Groups are introducing – not just in the new Integrated Care Provider contract.
This is made clear in an NHS England paper for their Board meeting on 31.1.19, which refers to both the Integrated Care Provider contract payment method and:
“other block contract arrangements [in addition to the Integrated Care Provider contract] and…the construction of Acts and Tariff rules, which supports the delivery of new and innovative service and payment models.”
From what we can gather, these “new and innovative” integrated care service and payment methods include aligned incentives contracts and other examples of what the NHS Strategy Unit calls “risk and reward sharing contracts“. It says:
“Risk and reward sharing is a key feature of the policy agenda for Accountable Care Organisations in the US and Integrated Care Systems in England… offering a commissioner the opportunity to co-opt and incentivise a provider to moderate growth in healthcare demand by sharing in the savings or cost over-runs. Risk and reward sharing can be seen as an end in itself, or as step in the journey towards capitated budgets and the full transfer of financial risk to providers.”
The Health Service Journal questions whether NHS England’s move to capitated budgets makes sense:
“There is … limited evidence from the US that risk and reward sharing contracts offer a step on the journey towards fully capitated budgets. The vast majority of accountable care organisations have not progressed to capitated budgets (as was envisaged), because they are unwilling to take on the increased risk.”
For information about why this all matters to patients, you can read What changes will patients notice in NHS Services run by Integrated Care Systems and Providers?