Making sense of accountable care

This report from the Kings Fund explores accountable care, and looks at the following questions:

  • Why is there so much interest in accountable care?
  • What is accountable care?
  • How does accountable care fit into the current legislative framework for the NHS?
  • What is happening in practice?
  • What does accountable care mean for commissioning?
  • What’s happening with new care models?
  • What’s happening in accountable care systems?
  • How is accountable care being implemented?
  • What has accountable care achieved?
  • Is accountable care about making cuts and privatising services?

The report concludes that accountable care should be supported because it offers the best hope for the NHS and its partners to provide the integrated health and care services required to meet the needs of the growing and ageing population. However, the author say that it will not deliver results quickly which is why national and local leaders need to make a commitment over the long term to developing accountable care as the main way of providing and funding care in the future.

Full report: Making sense of accountable care | Kings Fund

See also: Accountable care explained | Kings Fund blog

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Adoption and spread of innovation in the NHS

This report, commissioned by the Academic Health Science Network, looks at opportunities to accelerate the adoption of service innovation in the NHS, drawing on findings from eight case studies of successful spread of innovation in the NHS | Kings Fund

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From new communication technologies for patients with long-term conditions, to new care pathways in liver disease diagnosis, to new checklists for busy A&E departments, the report details the highs and lows of an innovator’s journey through the NHS.

While thousands of patients are now receiving new innovative treatments for arthritis, diabetes, cardiovascular disease and chronic liver disease, thanks to successful innovations, the report outlines the significant barriers that stand in innovators’ paths.

The case studies reveal common themes:

  • Providers need to be able to select and tailor innovations that deliver the greatest value given local challenges and work in the local context.
  • Fragmentation of NHS services remains a barrier to adoption and spread of innovation, making it harder to develop shared approaches and transmit learning across sites.
  • New innovations may appear simple to introduce but can have a domino effect – triggering a series of changes to diagnosis and treatment, revealing new patient needs and resulting in big changes to staff and patient roles. That’s why staff need time and resources to implement them.
  • As long as the NHS sets aside less than 0.1% of available resources for the adoption and spread of innovation, a small fraction of the funds available for innovation itself, the NHS’s operating units will struggle to adopt large numbers of innovations and rapidly improve productivity.

Full report: Adoption and spread of innovation in the NHS

 

Waiting times in A&E departments

Waiting times in accident and emergency (A&E) departments are a key measure of how the NHS is performing. In recent years, patients have been waiting longer in A&E; this article from the Kings Fund explores the reasons behind this.

The article reports that not only are more people are attending A&E departments each year, but A&E waiting times have also increased substantially over recent years. The NHS has not met the standard at national level in any year since 2013/14, and the standard has been missed in every month since July 2015.

At the same time, longstanding staffing issues and continued reductions in the number of hospital beds have made it more difficult for A&E departments to admit patients.

Full article: What’s going on with A&E waiting times?

Enhanced health in care homes

Enhanced health in care homes: learning from experiences so far | The King’s Fund

This report draws on published literature about joining up and co-ordinating care homes and health services. It also draws on interviews with a range of providers, local authorities and CCGs. It aims to help care homes and NHS providers (including GPs), local authorities and CCGs who are thinking through how to join up and co-ordinate services locally and how to manage the complexities involved.

The report makes recommendations for extending enhanced health in care homes to all areas, supporting and developing leaders, and ensuring that people living in care homes can access high-quality health care.

Full report: Enhanced health in care homes: learning from experiences so far

What does the Autumn Budget mean for the NHS and social care?

In the budget this week, the Chancellor committed around £2 billion extra for the NHS next year. Nigel Edwards of the Nuffield Trust said this will bring respite for patients and staff, but is only around half of what’s needed.

In a Q&A about the budget, Tom Moberly, The BMJ’s UK editor, met with John Appleby (Nuffield Trust), Anita Charlesworth (Health Foundation) and Siva Anandaciva (King’s Fund) to discuss what it all means for the NHS and social care. You can watch the discussion below:

See also: Autumn Budget 2017: what it means for health and social care | The Kings Fund | Nuffield Trust | The Health Foundation

 

 

Quality improvement

Establishing quality improvement approaches which actually work has much to do with suitable leadership and organisational culture, according to a new King’s Fund report.

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This report explores the factors that have helped organisations to launch a quality improvement strategy and sustain a focus on quality improvement. It identifies three common themes for successfully launching a quality improvement strategy: having a clear rationale; ensuring staff are ready for change; understanding the implications for the organisation’s leadership team in terms of style and role.

The report finds that NHS leaders play a key role in creating the right conditions for
quality improvement. Leaders need to engage with staff, empower frontline teams to
develop solutions, and ensure that there is an appropriate infrastructure in place to
support staff and spread learning.

Full reference: Jabbal, J| Embedding a culture of quality improvement | Kings Fund

Latest Quarterly Monitoring Report finds Patient care deteriorating

Half  of NHS trust finance directors think patient care in their area has got worse over the last year, while just six per cent said it has improved | The King’s Fund

Analysis for the Kings Fund latest Quarterly Monitoring Report suggests that the NHS is heading into winter on a knife edge with performance worse than at this time last year against a number of key indicators:

  • 89.7 per cent of A&E patients were seen within four hours in September compared to 90.6 per cent of patients in September last year.
  • 89.4 per cent of patients waiting for treatment in August had been waiting up to 18 weeks for treatment in August, compared to 90.9 per cent in August last year. This is missing the target of 92 per cent. There are now 4.1 million people waiting for treatment, the highest number since 2007.
  • Emergency admissions are three per cent higher in September compared to the same time last year.

The report also shows that NHS finances remain precarious.  Less than half of NHS trusts (45 per cent) expect to meet their financial targets this year, while commissioners are being forced to make tough decisions to reduce spending such as making people wait longer for planned treatment.

Trust finance directors also report widespread problems attracting nursing staff. The main reasons for this are the shortage in staff being trained; morale and work-life balance; and pay restraint.

Full report: The Kings Fund Quarterly Monitoring Report November 2017