Can accountable care organisations really improve the English NHS? Lessons from the United States

Alderwick, Hugh; Shortell, Stephen M.; Briggs, Adam

doi:10.1136/bmj.k921

Cited by 14 publications

(14 citation statements)

References 27 publications

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“…To help achieve these aims, ICSs are expected to ‘provide stronger foundations for working with local government and voluntary sector partners on the broader agenda of prevention and health inequalities’,2 although it should be noted that a close partnership with local government is not guaranteed. Indeed, the original STPs were criticised for not involving local government closely enough 19 23…”

Section: Integrated Care In Englandmentioning

confidence: 99%

Integrated health and care systems in England: can they help prevent disease?Integrated health and care systems in England: can they help prevent disease?

Briggs

Göpfert

Thorlby

et al. 2020

Integrated Healthcare Journal

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ObjectivesOver the past 12 months, there has been increasing policy rhetoric regarding the role of the National Health Service (NHS) in preventing disease and improving population health. In particular, the NHS Long Term Plan sees integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) as routes to improving disease prevention. Here, we place current NHS England integrated care plans in their historical context and review evidence on the relationship between integrated care and prevention. We ask how the NHS Long Term Plan may help prevent disease and explore the role of the 2019 ICS and STP plans in delivering this change.MethodsWe reviewed the evidence underlying the relationship between integrated care and disease prevention, and analysed 2016 STP plans for content relating to disease prevention and population health.ResultsThe evidence of more integrated care leading to better disease prevention is weak. Although nearly all 2016 STP plans included a prevention or population health strategy, fewer than half specified how they will work with local government public health teams, and there was incomplete coverage across plans about how they would meet NHS England prevention priorities. Plans broadly focused on individual-level approaches to disease prevention, with few describing interventions addressing social determinants of health.ConclusionsFor ICSs and STPs to meaningfully prevent disease and improve population health, they need to look beyond their 2016 plans and fill the gaps in the Long Term Plan on social determinants.

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Section: Integrated Care In Englandmentioning

confidence: 99%

Integrated health and care systems in England: can they help prevent disease?Integrated health and care systems in England: can they help prevent disease?

Briggs

Göpfert

Thorlby

et al. 2020

Integrated Healthcare Journal

Self Cite

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“…The NHS is moving, as are many other countries to a more collaborative approach to healthcare development (previously through integrated care programmes, and more latterly through a population-based approach to accountable/integrated care organisations and new models of providing care across organisations) (Pollock and Roderick, 2018). Markets are seen to have failed to deliver the increased quality and better value expected (Alderwick et al , 2018).…”

Section: Theoretical Contributionmentioning

confidence: 99%

Darzi Clinical Leadership Fellows: an activity theory perspective

Malby

Mervyn

Boyle

2018

JHOM

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Purpose The purpose of this paper is to review the impact of the clinical leadership programme, in enabling the Darzi fellows to lead change projects in health and care services, and to secure quality healthcare in the NHS beyond the lifetime of the programme. Design/methodology/approach A longitudinal empirical investigation of clinical leaders (n=80) over an eight-year period was framed through an activity theory (AT)-driven research methodology using a mixed-methods approach. Findings AT illuminated how change was sustained in the NHS in London through the Darzi Clinical Leadership Fellowship. By any reasonable measurement, this programme excels, with learning and positive behavioural change sustained after the Fellowship across the NHS. Further recognition is needed of the continuing development needs of fellows as they take on more responsible leadership roles in their careers. Research limitations/implications Darzi fellows are a hard-to-reach group. The sample represents a response rate of 34 per cent. In total, 77 per cent of respondents emanated from cohorts 5 to 8 programmes. Practical implications The investment in a clinical leadership programme focused on systems leadership for quality generates value for the NHS. Social implications Countless interventions flowed through London’s healthcare community and beyond as a result of the Fellowship. This research exposed how Darzi fellows continue to lead innovation for alternative healthcare outcomes. Many proactive fellows employ a suite of learned skills and capabilities to lead systemic change. Originality/value This research is the first known longitudinal clinical leadership development study undertaken. The Darzi programme has created a unique clinical network of mutually supportive, team-centric systems thinkers and doers, with an evidence-based approach to systems change. Many fellows are catalysing sustainable change in the healthcare environment.

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“…More recently, the trend has been towards broader whole population-based approaches [ 15 ], implementing a variety of interventions across population groups, tending to focus on scaling up prevention-based approaches. There have been well-known successes using this population-based approach, most notably Kaiser Permanente in the US [ 16 ], spawning a movement towards Accountable Care Organisations (ACO) [ 17 ]. However, it is not clear if the ACO findings [ 18 ] will translate to very different settings outside of the US.…”

Section: Introductionmentioning

confidence: 99%

New integrated care models in England associated with small reduction in hospital admissions in longer-term: A difference-in-differences analysis

et al. 2020

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Highlights Integration policies are often seen as strategies to reduce avoidable hospital activity. “New care models” were piloted in England under the “Vanguard” initiative. We evaluate the efficacy of the Vanguard programme in reducing hospital utilisation. The Vanguard initiative slowed the rise in emergency admissions observed in England. The reduction occurred mainly in care home sites, at the programme’s end.

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Can accountable care organisations really improve the English NHS? Lessons from the United States

Abstract: NHS policy makers should not copy US ACOs but they can learn from their experience, say Hugh Alderwick and colleagues

Cited by 14 publications

References 27 publications

Integrated health and care systems in England: can they help prevent disease?Integrated health and care systems in England: can they help prevent disease?

Integrated health and care systems in England: can they help prevent disease?Integrated health and care systems in England: can they help prevent disease?

Darzi Clinical Leadership Fellows: an activity theory perspective

New integrated care models in England associated with small reduction in hospital admissions in longer-term: A difference-in-differences analysis

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