1. RECONSIDERING ACCOUNTABILITY IN AN AGE OF INTEGRATED CARE BEN JUPP

2. ©Social Finance 2015 BACKGROUND 2 ‘Across the NHS we detect no appetite for a wholesale structural reorganisation’ NHS Five Year Forward View But also significant pressures for change With implications for accountability

3. ©Social Finance 2015 ACCOUNTABILITY AND COMMISSIONING 3 ‘The principal line of accountability for the NHS is through the commissioning line, following the flow of money from DH to NHS England to CCGs’ (Department of Health, 2014)

4. ©Social Finance 2015 IMPLICATIONS OF NEW MODELS OF INTEGRATED CARE 4 ‘New Models’ reflect wider developments in train New models of condition management HSJ Barometer found 70% of CCGs expected majority of GPs to join a single provider organisations in the next 4-5 years before publication of Five Year Forward View ‘A combined health and social care budget could be delegated to Multi- speciality Community Providers’ Five Year Forward View Reflects a wider shift in the bringing together of some ‘commissioning’ functions with provider functions – Internationally in health systems – Alzira, Accountable Care Organisations – In other services: employment support, schools, probation Alongside significant financial pressures in social care and merging of health and care needs

5. ©Social Finance 2015 IMPLICATIONS FOR COMMISSIONING AND ACCOUNTABILITY 5 How can commissioning become more strategic? Bringing together primary, secondary and potentially elements of social care? What knowledge and skills to manage and oversee a capitated budget and contracts? Who is best placed to provide strategic accountability – in particularly will GPs be both too conflicted and have the right skills to oversee new integrated providers? At what geographical level? Where to draw the boundaries? Social Care, wellbeing, employment, environment? An evolutionary approach has many advantages, but need to think through the difficult decisions now

6. ©Social Finance 2015 SOME LESSONS AND QUESTIONS 6 1. Provider governance is important too – accountability for detailed service planning will need to rest with providers 2. Transparency and appropriate regulation and inspection may become more important 3. Do ‘combined authorities’ offer a way to commission strategically 4. New ways to engage local elected representatives

7. ©Social Finance 2015 THANK YOU 7 ben.jupp@socialfinance.org.uk