practical lessons to develop an stp and acs - gerard hanratty, browne jacobson
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Practical lessons to develop an STP and ACSPractical tips on the law, governance and servicechange – Gerard Hanratty, Browne Jacobson
Practical Tips on the Law,Governance and ServiceChangeGerard Hanratty29 November 2017
General Issues
• Have you agreed a system wide understanding ofyour aims?
• Are all relevant bodies engaged – including thepatients, public and service users?
• Do you have a clear and agreed plan and/or casefor change?
• Has the legislative framework been overlaid onyour regional and place governance arrangements?
• Are you in control of dialogue with (P/p)oliticians ?
What is in an acronym -ACOs/ACSs/ACPs/LCPs/LAC?• Have you discussed and defined your acronyms and
is everyone working from a shared understanding?• Are you building on a model that partially provides
care through an ACS type approach?• How are you integrating health and social care
commissioning and provision?• Legislation – help or hindrance?
Governance
Legally how do ACSs work?
• Following slides set out where we started and aproposed governance framework for the future.
• A number of ACSs have morphed into this fromSTPs or are using a similar looking model for ACSdevelopment.
• Many want answers on how to take forward policyand plan at least risk to statutory organisations.
• This proposes a known and simple starting point.
Legal Roles and Responsibilities within the ACS
ACS Programme Board
Legal Issues that applyto the set up of the
governance framework
Local/CombinedAuthorities Forum
NHS StatutoryProviderForum
NHS CCG jointcommittee
NHS Act
CCG constitution
Provider Licence/ FTConstitution and/or
Sos/SFIs
Procurement andCompetition
NHS Act
NHS ImprovementGuidance
Guidance including onConflicts of Interest,
Reconfiguration
NHS Act
Local AuthorityLegislation
Legal Role of ACSProgramme Board: Advisory,Co-ordination and PMO (butnot decision-making)
Decisions are retained atNHS entity Level.
The ACS programme boardoperates to co-ordinate andfacilitate decision-makingacross system
Commissioner and CCG/LA Led Workstreams Provider Led Workstreams
Procurement andCompetition
Case Law
Non NHS ProviderForum
GP Provider &Federations Forum
Bringing everythingunder one roof
Local/CombinedAuthorities Forum
NHS StatutoryProviderForum
NHS CCG jointcommittee
Commissioner jointworking/CCG merger
Commissioner LedNew Care Models
Estates and Corporateservices shared
working; Better use ofworkforce
Provider led clinicalservices New Care
Models or Jointworking
Joint Ventures, Mergersand AcquisitionsReconfiguration of
services
Pooling of funds,section 75 and
partnership working
Aims of the ACS:
Benefits to patient care
Financial sustainability
System-wide control
Non NHS providerforum
Accountable Care System
Such as• Community Hospital
reconfiguration• Proposals for acute
service change• NHS Improvement to
support alignment ofplans across borders
• Ambulance sustainability• Funding released from
joint specializedcommissioning for STP
• Joint working with LA• CCG merger
Commissioner and CCG/LA Led Workstreams Provider Led Workstreams
GP FederationsACS Programme Board
10
Governance Structure (1)
ProgrammeManagement Group
Finance and Investment
ACS Programme Board
Chair: Independent or Local
Clinical BoardCommunications &
EngagementEnabling Work
Streams
11
Governance Structure (2)
ProgrammeManagement Group
Finance and Investment
EstatesWorking
Group
ACS Programme Board
Chair: Independent or Local
Clinical Board Comms & Engagement
Care Sector PrimaryCare
MentalHealth
Urgent &Emergency
Acute &SpecialisedPrevention
Equalities
SteeringGroup
TravelAdvisory
Group
Enabling Work streams
Workforce
DigitalHealth
Out ofHospital
Back OfficeConsolidationprogramme
OD
Service Transformation andReconfiguration
Service Transformation in an ACS
• Is this is in your aims and plan? What are youseeking to achieve?
• Have you done a sustainable services analysis?• What are options for change – clinical pathway,
chain model delivery, procurement (light touch),merger or change with public consultation
• Is the case for change clear and agreed in system?• How will your governance process work? (hint-see
above)
What is the ? in the Room
The Clever bit…….
• Clearly understand your legal obligations – this iswhat you can be judicially reviewed on!
• The commissioners are the decision makers andcomply with procurement obligations in making it
• Understand the interconnectivity of services• Do you understand what NHS England expect to see
in your PCBC – 4 key tests, bed closure tests,patient benefit, clinical senate approval andMONEY!
And even cleverer………
• Clear evidence and information on website• Are you confident you have complied with
technical legal asks? [e.g. equalities, GDPR]• Be sensitive throughout to potential challenges
from local authorities (incl HOSC) and public• Any gap or mistake in the process can be corrected
before the final decision is made• Be positive in your consultation document – explain
patient benefits and MONEY - IRP too defensive
Nearly done…..
• Publicise meetings and encourage invites• People trust doctors and stalls v stages• Be clear on how responses will be assessed and
then fed into decision making process• Have a clear and full DMBC for the commissioners
to use and that should be the basis for any FBCseeking capital by providers
The Eureka moment!
• There is nothing new in law – (well apart from theGDPR but that is for another day)
• The public are you and me• Transparency on money and a clear view on patient
benefits is often what people want to discuss• Attachments to bricks and mortar needs to be
understood but they do no provide care• The future and co-production of local provision• Implementation and review is the final element
Conclusions (1)
• Clarity of approach to deliver an ACS is essential– Simple model – public understanding is key– Corporate memory - Handbook
• Joint understanding of what you mean by ACS– What do your region and localities need?– Who will be involved?
• Back to the Future on creating an ACS (but withbuilt in management of commissioning functions)
• Strategic commissioner and regulator
Conclusions (2)
• Service Transformation/reconfiguration has threestages– Understanding why change is needed and being clear
on case for change– Making a decision on how to change commissioning
arrangements and service provision– Implementation needs to be properly approached
and services reviewed
• Transparency, information and legal framework
Any Questions?
