We have been working on a number of evaluations of innovative new care models recently, so we were really interested by the recent report from the Kings Fund on the development of accountable care systems in Canterbury, New Zealand. Although it does clearly identify that the approach taken has had a positive impact in terms of increasing care available in the community, engendering closer links between primary and secondary care, reduction in hospital spend, particularly on diagnostic services, and a general reduction in demand for hospital services and residential care services, it has not saved significant amounts of money.
However, what it appears to have done is manage over an extended period of time (around 10 years) a transition of funding from one type of provision and support to another, albeit one that appears to offer better quality outcomes for citizens. The concern for the NHS, therefore, in its accelerated adoption of accountable care systems is that sufficient time needs to be provided for new models of care to be implemented and embed before conclusions about their success or otherwise are drawn. More importantly their principle outcomes should be an improvement in service design, quality and value for money, rather than as a means to save money.
In children’s services, the Department for Education’s omnibus research highlights that nearly 1 in 5 local authorities are not able to analyse need/demand for children’s social care and 2 in 5 do not have a team or function in place to assess the impact of different interventions.
Given the squeeze on children’s services budgets and the increasing focus on evidence-based practice, we believe that this shortfall needs to be quickly addressed. We are working with a number of local authorities to help them assess the impact of practice with children and families with complex needs. We hope to help embed this way of working so that teams have in-house capacity to do this on an ongoing basis.