NHS England has recommended that Sustainability and Transformation Partnerships (STPs) should evolve over time into Accountable Care Systems (ACSs) but how easy/difficult is this to achieve? The Kings Fund has recently produced a report which looks at the health system in Canterbury, New Zealand and how it transformed fragmented care into integrated care resulting in reduced demand secondary care.
The Kings Fund suggest that the NHS can learn from the Canterbury experience, as the drivers for change in both Canterbury and the NHS today are very similar:
- Financial pressures
- Increasing demand – for both elective and non-elective care
- Struggling A&E departments
- Ageing population
The focus for change in Canterbury was to provide care for people within their own homes wherever possible by providing the right care by the right person at the right time. Canterbury aimed to achieve this through;
- better integration and coordination of primary, secondary and tertiary health services through health alliance and new ways of contracting.
- the development of a shared vision, ‘one system, one budget ‘, and the empowerment of teams at all levels and from across the system to be innovative
- investment in staff skills
As a result of these changes, compared with the rest of New Zealand, Canterbury has lower admission and readmission rates, shorter length of stay and lower spending on emergency care. The system has also reduced waiting times and spending on diagnostics through an improved primary/secondary care interface.
Given the pressure similarities faced by both Canterbury and the NHS at the start of the Canterbury journey, and the positive outcomes Canterbury has achieved to date, what can the NHS learn from Canterbury?
The Kings Fund suggests the following:
- Have a clear, shared strategic vision
- Strong leadership with continuity
- Use alliance contracting models to share risks and rewards
- Emphasise system working and staff engagement
- Invest in technology and active encouraging of clinicians, patients and other partners to develop innovative solutions
- Consider how general practice is organised
- Understand it will take time – a decade to date in Canterbury – to achieve
- Investment is necessary – the experience in Canterbury has not reduced hospital beds, but has reduced the demand for acute care. The NHS is currently receiving little additional funding but is tasked with making significant changes. The Canterbury model suggests that investment is necessary for change, with the focus being on reducing demand for acute care rather than cutting hospital beds or services