Shakespeare’s infamous words from Romeo and Juliet could not be more fitting when it comes to the latest health policy buzz phrase. What matters is what something is, not what it’s called.
If you can’t tell an STP from an ACS, let alone know what an ACO is, don’t worry you’re not alone. The NHS is well known for its acronyms. Many an acronym buster have been compiled to help make sense of them (and there are literally hundreds), but it seems these three in particular are leaving people, including healthcare professionals, somewhat bewildered.
To try and put it as simply as possible, 44 Sustainability and Transformation Plans (STPs) were put together across the country towards the end of 2016 to support the implementation of the Five Year Forward View. These are ‘place-based plans’ for the future of health and care services in each area. Ten of these will progress into Accountable Care Systems (ACSs) which, then in turn, are expected to become Accountable Care Organisations (ACOs). The latter will bring health bodies, such as hospital trusts, GPs or mental health trusts, together with local government, to create a single organisation.
From my experience working first hand with NHS leaders they don’t get hung up on jargon, they just want to deliver the best possible care to patients. This sentiment was echoed at a recent panel event I attended where one of the panel members, a former hospital trust CEO, urged everyone to “stop debating three letter acronyms”, and that “it doesn’t matter what we call them as long as they’re about people working together across a system to deliver population based healthcare.”
This is definitely true, however, with any major change, particularly in healthcare, it’s vital to get the public onside with the right communications. They need to understand what it is you’re trying to do and why it’s needed. Previous (unsuccessful) cases of proposed A&E closures are a case and point. And if there’s already confusion about what an ACS is amongst the NHS and policy makers then what hope does the average patient have?
Earlier this month both the King’s Fund and the House of Commons Library put together explanatory guides on accountable care. These have been welcome additions to the communications already put out by NHS England. Both emphasise the move towards accountable care as an attempt to make sense of an increasingly complex and fragmented system, to enable organisations to work together, crossing organisational boundaries to meet the needs of their local populations.
Whilst the NHS is diligently getting on with this, developing and starting to implement their transformation plans (or at least trying to) no one can ignore the elephant in the room – surely changes to NHS structures and how organisations work together requires legislation? It was initially thought that with a minority, and increasingly weakened, government whose time and attention is firmly placed on Brexit, legislation on the NHS would be off the agenda. However, recent comments from the Health Secretary and others have suggested that legislative changes could be introduced into a bill as soon as next month.
This was until the announcement from NHS England last week on the launch of its consultation on ACOs, which intends to provide further “clarity” about what ACOs actually are. As part of this they are holding a 12-week public consultation to try and engage the public in the debate and put their case forward. This consultation makes it highly likely that any legislation that was planned will now be delayed until the consultation is over, in order to incorporate the findings.
In the meantime, it looks like NHS organisations will have to make progress with accountable care within the existing statutory framework. Nevertheless, such an approach is risky, as demonstrated by the two legal challenges currently facing the draft ACO contract, one from the campaign group 999 Call for the NHS, and another from a group of five campaigners, including Professor Stephen Hawking, known as JR4NHS. Given this and the fact that NHS England have said they won’t award an ACO contract whilst the consultation is going on, it does prompt the question as to where this leaves the NHS and those who work alongside it.
Despite some reports suggesting this is potentially the end of ACOs before they’ve even begun, in reality it only effects two areas at the moment – Dudley and Manchester – and the former had already announced they were having to delay the procurement of their ACO contract. However, the fact that even the most advanced areas have come to their own standstill is worrying. It provides yet more uncertainty, in an already volatile system, as to what the roles of the key players and partners are. For instance, CCGs are making the case for their new strategic role in these new forms, but are still concerned about where the accountability will actually lie in the new landscape.
It’s fair to say STPs, ACSs and ACOs have had a tricky start and this is partly because of the confusion over what they actually are. What is clear though is that their intention, to promote collaboration by breaking down barriers between organisations and services, is not just an admirable one but a necessity if we’re to make the NHS sustainable whilst also improving the offer for patients.
So it’s not really important what we call it, whether it’s an STP or an ACS, it’s that it achieves its ambition that matters. The recent stumbling blocks have understandably caused some concern as to what it means for future relationships between, and with, NHS organisations and whether they will actually have a lasting impact. All eyes are now on the outcome of the NHS England consultation and potential legislation which should make these changes, and their impact, clearer.