Practical lessons to develop an STP and ACS - Gerard Hanratty, Browne Jacobson

Practical lessons to develop an STP and ACS
Practical tips on the law, governance and service
change – Gerard Hanratty, Browne Jacobson

Practical Tips on the Law,
Governance and Service
Change
Gerard Hanratty
29 November 2017

General Issues
• Have you agreed a system wide understanding of
your aims?
• Are all relevant bodies engaged – including the
patients, public and service users?
• Do you have a clear and agreed plan and/or case
for change?
• Has the legislative framework been overlaid on
your 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?

Legally how do ACSs work?
• Following slides set out where we started and a
proposed governance framework for the future.
• A number of ACSs have morphed into this from
STPs or are using a similar looking model for ACS
development.
• Many want answers on how to take forward policy
and 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 apply
to the set up of the
governance framework
Local/Combined
Authorities Forum
NHS Statutory
Provider
Forum
NHS CCG joint
committee
NHS Act
CCG constitution
Provider Licence/ FT
Constitution and/or
Sos/SFIs
Procurement and
Competition
NHS Act
NHS Improvement
Guidance
Guidance including on
Conflicts of Interest,
Reconfiguration
NHS Act
Local Authority
Legislation
Legal Role of ACS
Programme Board: Advisory,
Co-ordination and PMO (but
not decision-making)
Decisions are retained at
NHS entity Level.
The ACS programme board
operates to co-ordinate and
facilitate decision-making
across system
Commissioner and CCG/LA Led Workstreams Provider Led Workstreams
Procurement and
Competition
Case Law
Non NHS Provider
Forum
GP Provider &
Federations Forum

Bringing everything
under one roof
Local/Combined
Authorities Forum
NHS Statutory
Provider
Forum
NHS CCG joint
committee
Commissioner joint
working/CCG merger
Commissioner Led
New Care Models
Estates and Corporate
services shared
working; Better use of
workforce
Provider led clinical
services New Care
Models or Joint
working
Joint Ventures, Mergers
and 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 provider
forum
Accountable Care System
Such as
• Community Hospital
reconfiguration
• Proposals for acute
service change
• NHS Improvement to
support alignment of
plans across borders
• Ambulance sustainability
• Funding released from
joint specialized
commissioning for STP
• Joint working with LA
• CCG merger
Commissioner and CCG/LA Led Workstreams Provider Led Workstreams
GP Federations
ACS Programme Board

10
Governance Structure (1)
Programme
Management Group
Finance and Investment
ACS Programme Board
Chair: Independent or Local
Clinical Board
Communications &
Engagement
Enabling Work
Streams

11
Governance Structure (2)
Programme
Management Group
Finance and Investment
Estates
Working
Group
ACS Programme Board
Chair: Independent or Local
Clinical Board Comms & Engagement
Care Sector
Primary
Care
Mental
Health
Urgent &
Emergency
Acute &
Specialised
Prevention
Equalities
Steering
Group
Travel
Advisory
Group
Enabling Work streams
Workforce
Digital
Health
Out of
Hospital
Back Office
Consolidation
programme
OD

Service Transformation and
Reconfiguration

Service Transformation in an ACS
• Is this is in your aims and plan? What are you
seeking 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)

The Clever bit…….
• Clearly understand your legal obligations – this is
what you can be judicially reviewed on!
• The commissioners are the decision makers and
comply 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 and
MONEY!

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 FBC
seeking capital by providers

The Eureka moment!
• There is nothing new in law – (well apart from the
GDPR 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 with
built in management of commissioning functions)
• Strategic commissioner and regulator

Conclusions (2)
• Service Transformation/reconfiguration has three
stages
– 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

Talk to us…
Gerard Hanratty – gerard.hanratty@brownejacobson.com
0330 045 2159 / 07921 685815

Practical lessons to develop an STP and ACS - Gerard Hanratty, Browne Jacobson

Recommended

Recommended

More Related Content

What's hot

What's hot (15)

Similar to Practical lessons to develop an STP and ACS - Gerard Hanratty, Browne Jacobson

Similar to Practical lessons to develop an STP and ACS - Gerard Hanratty, Browne Jacobson (20)

More from Browne Jacobson LLP

More from Browne Jacobson LLP (20)

Recently uploaded

Recently uploaded (20)

Practical lessons to develop an STP and ACS - Gerard Hanratty, Browne Jacobson