What does the Accountable Care System really mean in Cornwall?

What does the Accountable Care System really mean in Cornwall? This might be a reasonable question that many folk are asking, given what seems a Political spat in the media. This is what Rob Rotchell, Cabinet Member for Adults, has put out.

Rob Rotchell

Rob Rotchell, Cabinet Member for Adults, in Cornwall, leading on Health and Social Care Integration

The NHS and local government in Cornwall and the Isles of Scilly are agreed that the way services are currently commissioned and provided won’t address the changing the needs of their .local communities. Doing more of the same is financially unsustainable and will not guarantee that quality and safety of care will improve.

All agree that the approach needs to change. Our combined view is that they need to work together as an Accountable Care System (ACS) to enable more integrated care that serves the needs of the whole population.

An ACS does not change each organisation’s statutory and legal responsibilities. Instead it describes a way of working together that allows for a one strategy, one budget and one plan approach which  puts the person not the organisation first.

As well as being in agreement about the approach, all are signed up to making progress and testing out the practicalities by working in shadow form during 2018/2019.

The shadow ACS will operate within the existing statutory framework which means that the Councils, NHS England, the CCG and provider trusts will remain the statutory accountable bodies in the system.

Work will be supported by an accord which describes the principles of collaboration agreed by all partners involved in the ACS.

Why now?

Like many other areas across the country, local health and care services are facing a number of challenges – people are living longer, an increasing number of people have multiple, long-term conditions, and when people do need care, they receive it a variety of different ways – in hospitals, from their GPs and primary care staff, in clinics, nursing homes and from home care agencies.

Recent Care Quality Commission (CQC) reports into local health and social care have made it clear that services are not sufficiently or consistently meeting people’s needs. It found that:

•       The quality and safety of care services is not consistently good enough

•       Patients described  their experiences of receiving care as not always good – although they generally had a more positive experience of services provided by their GP surgery

•       People often  had poor experiences of moving out of hospital and to a care home or back home with social care support – they described coming up against a lack of choice, poor information sharing between organisations and a lack of home care packages

•       Patients who were discharged from hospital and needing ongoing support, found the arrangements to try to help them confusing, despite the efforts of frontline staff and care teams

What is being planned and what is the timescale?

We recognise some people are concerned by this proposal but this is not about privatising the NHS.  An accountable care system simply means that the overall health and care system works better together in the interests of patients and the wider community.

There is no single model for accountable care systems in England, with different local areas developing their own approaches. We want to work with individuals and organisations to develop a Cornwall and Isles of Scilly model which both co-ordinates care across the whole health and social care system and improves the health and wellbeing of the wider population.

It is proposed that the local shadow ACS will be made up of:

•       A small, Integrated Strategic Commissioning Function for health, care and wellbeing services

•       One or more Accountable Care Partnerships (ACP), where groups of providers work together as a single network, taking collective responsibility for the effectiveness of service provision, with the ability to design new ways of working and move the money round the system to deliver more joined up, better coordinated and more efficient care.

A guiding principle of the work to develop an Accountable Care System is to be open and transparent and to allow for debate and discussion about proposals as plans progress.

An important part of this work will be  a  series of three  inquiry days in December and January to learn from other areas that are setting up Accountable Care systems and draw up recommendations on the way forward.  These sessions will be open to the public and will be led by a panel of five Cornwall Councillors, chaired by Andy Virr.

The purpose of the inquiry days is to hear from representatives of local health and care organisations and from those areas developing an ACS, NHS England and patient groups such as Healthwatch.

At the end of the inquiry days, the councillor panel will draw up recommendations specifically about the development of the integrated strategic commissioning function of the ACS. These will then be considered at an extraordinary meeting of the Health and Adult Overview and Scrutiny Committee at the end of January, with a report being presented to the Council’s Cabinet in February, followed by full Council. The recommendations will also be discussed by the Kernow CCG Governing Body. Information on the inquiry days

More information on the ACS can be found on the Shaping Our Future website: Shaping Our Future on Accountable Care Systems