NHS system leaders have called for a new payment scheme that incentivises prevention and allows for more flexibility, in the NHS Confederation’s latest report.
Changing the payment scheme could allow for better technical productivity and efficiency and ICBs should be supported to experiment locally through pilots, it states.
The report, which also surveyed integrated care system (ICSs) – with 36 of 42 responding – found that 90% of ICS leaders said they were committed to shifting resources to allow more people to access care closer to home, but they were struggling to match the ambition due to financial constraints.
The report, The state of integrated care systems 2023/24: tackling today while building for tomorrow, also recommended multi-year funding deals as the ‘only way’ ICSs would be able to deliver their long-term ambitions.
It said: ‘Instruct relevant departments – in this case the DHSC to NHS England – to outline Spending Review length funding allocations for both revenue and capital. This would bring the NHS in line with the government’s commitment to give councils multi-year funding settlements.
‘Allow for a proportion of this funding to be front-loaded to be spent in the first year for outcomes-based care for the length of a Spending Review and place a moratorium on further ringfenced non-recurrent funding. Instead, give ICBs and trusts the realistic full sum available for the year based on agreed outcomes, rather than delivering it piecemeal.’
The report also found that only 40% of ICS leaders surveyed believed that accountabilities were well defined between ICBs and NHS England’s national team.
It echoed calls in the Lord Darzi review to clarify accountabilities which are ‘unclear’.
It said: ‘System leaders welcome appropriate accountability and recognise the important role played by regulation and oversight in healthcare provision, but highlight that the current framework is severely flawed.
‘System accountability arrangements are multi-layered. Individual NHS providers (trusts, foundation trusts and primary care providers) are accountable to ICBs and national bodies, including DHSC, NHS England and the CQC.
‘ICSs collectively are accountable to their local populations (foundation trusts are formally accountable to their local populations through council of governors) and partners within them are mutually accountable for the delivery of the integrated care strategy. ICBs are accountable upwards to national bodies. Balancing multiple masters can be challenging.’
It also called for more ‘levers’ to progress the devolution of decision-making to place and neighbourhoods and that integration at place would be a key theme of the government’s 10-year plan for health.
