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1240/5/1(481)
WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY DEPUTY G.P. SOUTHERN OF ST. HELIER
ANSWER TO BE TABLED ON TUESDAY 12TH SEPTEMBER 2017
Question
Will the Minister inform members what relationship, if any, exists between his plans for a new governance model, Health and Social Care System: a new governance model' (P.60/2017), and the creation of a Sustainability and Transformation Partnership (STP) or an Accountable Care Organisation (ACO) for the Jersey health service?
Answer
Sustainability and Transformation Partnerships (STPs) are a relatively new concept in the NHS. They develop plans to transform health and care in the period to 2021, building and strengthening local relationships to deliver on the NHS Five Year Forward View'.[1]
In early 2017, NHS England outlined plans for STPs to become Accountable Care Systems or Accountable Care Organisations. These are groups of service providers which collaborate to meet the needs of a defined population, having budgetary responsibility and being accountable for delivering agreed outcomes[2].
In Jersey, we already have a health and social care system with significant integration. This is in contrast to England, where responsibility for policy, strategy and delivery is divided between numerous organisations. This can hinder true integration and partnership, as it means the individual organisations have to set aside their individual interests for the greater good of the system, which is a significant challenge in a system which has increasing financial constraints.
Our strategic work since 2010 also means that Jersey is ahead of the NHS in terms of transformation plans – our transformation plan was outlined in P82/2012 A New Way Forward for Health and Social Care', which was approved in the States on 23 October 2012.
Since then, partners from across health and social care have worked together to develop and implement detailed plans which ensure care remains safe, sustainable, affordable and is integrated and delivered in partnership – this was the vision of P82 and remains core to our whole health and social care system strategy.
Senior representatives from partners across health and social care continue to meet regularly to oversee this transformation. This includes partners from the voluntary sector and Primary Care.
However, unlike the NHS, we do not yet have a fully inclusive public and patient engagement programme, and a clear and visible way for Islanders to contribute to strategic decisions about the health and social care that their taxes fund. Nor do we have the same level of transparency and visibility that is enjoyed in the NHS, where Board meetings are held in public, led by an independent Chair and Non-Executive Directors. We also need to strengthen the involvement and influence of care professionals and the voluntary sector. These three elements are common in a range of international health and social care systems, including New Zealand, Alaska and Sweden.
The new governance model outlined in P60/2017 (and to be debated in November) aims to improve transparency and participation in strategic decision making for health and social care. It will provide a greater opportunity for care professionals, the voluntary sector and the public to participate in and to understand strategic decisions.
P60/2017 does not propose any changes to the organisational form or structure for health and social care on the Island. Nor does it propose any changes to the current accountability structures – the Chief Executive Officer will remain accountable to the Minister. The Minister will remain Corporate Sole, being accountable to the States Assembly through the Council of Ministers. He/she will ultimately make decisions regarding health and social care, but, in the future, if P60/2017 is approved, these decisions will consider the recommendations of the Strategic Partnership Board, which comprises representatives from the Health & Social Services Department, Clinical and Professional Forum, Voluntary Sector Forum and Public and Patient Forum.
It is proposed that the new governance model would be piloted in the first instance. If it is successful and proves its value, States Members may wish to consider progressing towards an Accountable Care System of service providers in the future. As noted by the Kings Fund, this does not necessarily require a change of organisational ownership or accountability; it can be a group of providers working together in a partnership alliance with shared outcome goals for defined areas of the population or for the whole population. However, it is important to note that such changes in the future will only take place if the Minister of the time recommends them to the States Assembly.