Having previously discussed Sustainability and Transformation Plans (STPs) in this column, I have followed their progress locally and nationally. After all they are described as ‘the only show in town’ with regard to getting the National Health Service back on track and so we should all be taking a very active interest.
Having spoken to people from various areas, an STP strikes me as being like people’s view of Heaven, everyone would like to go there, it will be a good place to be, but no one really knows what it looks like. In fact if you ask two people from the same geographic area what the health landscape will look like post STP, more likely than not you will get two different answers.
To be fair you may hear some common final aims of the STP to address the three gaps of health and well-being, care and quality, and finance and affordability, however that translates to real action still appears to be a mystery. It is interesting that some areas now refer to their Sustainability and Transformation Partnership, rather than Plan, however, whether this adds any clarity, I’m not sure.
To add to the confusion we now have a number of areas that are developing an ‘Accountable Care System’, ACS, which is a new, person-centred model of care, designed to help close the three gaps already mentioned. The ACS is an alliance of providers, who take responsibility for a budget allocated by commissioners to deliver a range of agreed services and outcomes to meet the needs of a population.
It is envisaged that an ACS will organise care around individuals and populations – not organisations – and help people remain independent through prevention programmes and offering proactive rather than reactive care. The ACS will support and provide care for people at home and in the community as much as possible and ensure that hospital, care home beds and supported housing are available for people who need them.
There will be multidisciplinary collaboration across organisational boundaries to deliver integrated care as simply as possible. Finally, and perhaps most relevant to the optical world the ACS will minimise inappropriate variations in access, quality and cost and deliver care and support as efficiently as possible to maximise the proportion of budgets that are spent on improving health and well-being.
How does this fit alongside the STP? Depending on what you read or who you talk to, the ACS will be an enabler to the STP, for others the STP will evolve into yet another system, an Accountable Care Organisation (ACO).
Whatever is exactly the order of events, for those of us who worry that this is yet another harebrained idea from the Department of Health, at least this time there is thinking taken from systems around the world, such as in Spain, Sweden and New Zealand, and closer to home Manchester is taking a lead in system wide change. Here the work extends beyond health and social care to include public health and other services.
You can see that there are very lofty ambitions but my concern is the lack of detail – how it will be achieved and who will make it happen, other than the hope that everyone will work together to a common aim. Take a typical STP area, where there may be two hospital trusts, a mental health trust, five clinical commissioning groups, a public health department, GP surgeries, dental and optical practices and who knows how many other interested groups who contribute to the total health economy.
It is likely that a great deal of change is required. Budgets would need to devolve from one organisation to another, there may be merging of groups required and inevitably there will be winners and losers as we move towards a more effective system. In this scenario is there an incentive (other than they will be doing the right thing) for some to work towards an outcome where they will have less influence? To get these groups effectively working together will be a tall order and will require an effective leader with the authority to make difficult decisions when any of the various organisations are not moving forward due to misplaced self-interest.
Does this have any relevance to optical practice? Well of course it does. Under the current system we are not achieving our aims to get consistent involvement in eye health, as evidenced by variations across the country and even at county level. Other than the GOS sight test, almost everything else such as eye care pathways, children’s screening and low vision provision, is variable.
The take home message is that we want STPs/ACOs to succeed as they play to greater primary care involvement.