There are numerous definitions of integrated care. There are also different levels at which care can be integrated: patient-level, service-level and organisational-level (see Chapter 2). NHS England’s current definition of integrated care is care that is “person-centred, coordinated, and tailored to the needs and preferences of the individual, their carer and family. It means moving away from episodic care to a more holistic approach to health, care and support needs, that puts the needs and experience of people at the centre of how services are organised and delivered.”
Place-based care involves local service providers collaborating and sharing the resources available to them to improve health and care for the populations they serve. This concept has been extended to planning and commissioning of services through examples such as sustainability and transformation partnerships and integrated care systems.
Accountable care refers to an organisation or organisations taking responsibility for the health and care of a defined population within a set budget. Accountable care, according to The King’s Fund, is a synonym for integrated care, as it is built on organisations working together to meet the needs of their local population. Another benefit of accountable care is that holding a set budget for the health and care of a local population incentivises providers to improve population health. ICSs, ICPs and ACOs are all expressions of accountable care.
Sustainability and transformation partnerships are made up of NHS organisations, including clinical commissioning groups (CCGs), NHS trusts and foundation trusts and primary care services, as well as local authorities. They were originally established to produce a plan setting out how they planned to deliver the NHS Five Year Forward View, but have since become a mechanism for delivering other national priorities. There are 44 partnerships across England. The number of bodies involved in these partnerships and the size of the STP population varies considerably. They are a mechanism in which local bodies can plan changes to the shape of health and social care services locally. However, the partnerships are not legal entities and do not have authority to take forward decisions themselves. Decisions must be agreed separately by the organisations involved.
The forty-four footprints cover the whole of England, but vary considerably in the size of the area they cover and the populations they serve.
NHS organisations were asked to come together, with local government and primary care where possible, to create local blueprints for delivering the NHS Five Year Forward View, known as sustainability and transformation plans (STPs). These plans were published in December 2016 (see Chapter 4).
Sustainability and transformation footprints refer to the geographical boundaries of STPs (see Chapter 4).
According to The King’s Fund, integrated care systems in an area are taking more collective responsibility for “planning and commissioning care for their populations and providing system leadership” (see Chapter 4). ICSs have evolved from STPs, but are not legal entities. There are 10 ICSs which are setting a path for the remaining areas to progress to this status.
The NHS Five Year Forward View announced the creation of new ways of delivering care which blurred the traditional boundaries between services. These have been piloted across 50 sites in England. For example, integrated primary and acute systems, is a new model of care which joins up hospitals with community and mental health services as well as primary care.
ICPs are alliances between hospitals, community services, mental health services and GPs, but may also include social care and third sector providers. Providers in these alliances collaborate rather than compete to deliver health and care services for their local populations.
ACOs in the US were established by the US Affordable Care Act 2010. ACOs vary widely. This is important as they are likely to take a very different form when introduced to the NHS in England. The King’s Fund argue ACOs are likely to be:
a more formal version of an ACP that may result when NHS providers agree to merge to create a single organisation or when commissioners use competitive procurement to invite bids from organisations capable of taking on a contract to deliver services to a defined population.
268 NHS England, Integrated care and support, accessed on 2 June 2018
269 The King’s Fund, Making sense of accountable care, January 2018
270 The King’s Fund, Making sense of accountable care, January 2018
271 The King’s Fund, Making sense of accountable care, January 2018
Published: 11 June 2018