Health & Care bill could destroy the NHS with a PACS model

Could the English Health & Care bill destroy the NHS with a PACS model?

The newly proposed integrated care system (ICS) includes several 'new' ways of working - these are called new 'models of care'.

Here, we look at the PACS business model of care which is included in the governments Health & Care Bill before parliament mid-Nov (2021). 

Observations here are from the Salford Together trial program report; and summarises the key findings, learning and recommendations from the end of programme evaluation of Salford Together’s Adults Integrated Care Programme (ICP).

Integrated Primary and Acute Care Systems (PACS)

Vanguard (kaiser beacon pilot program): Salford Together

The PACS model is to be applied to all footprint regions across England.

The PACS model is a population-based new care model based on the American  Accountable Care model (pg 5 pacs framework NHSE).

It appears rollout will be done regardless of whether the Salford Together vanguard program is successful or not (surprise surprise).

Since the program is running in parallel with existing services, it does not and cannot, truly be presented as an 'evidence-based' model. 

Rolled out on a larger scale the PACS model could be a disaster due to existing services being closed before any meaningful results are recorded.

The evaluation report ran up to the pandemic (up to June 2020).

When reading through the report it's important to look closely at the figures - however, it was soon discovered existing figures (eg A&E attendances) were either omitted altogether or presented as percentages. 

Further, when part of a program or pathway wasn't working they changed it. But fail to say what these changes were.

Also, in an integrated combined system that must work together, "pockets of success" equates to "failure of the rest of the system. 

The summary from stakeholders described the PACS program as:

"an aspirational aim, which had not been fully achieved"

The report (link below to PDF) then proceeds to the "what have we learned and recommendations" (page 7)

Some high-risk problems encountered on the scheme include:

1. Problems accessing data [catastrophic in an integrated system], 
2. quality and complexity; [high risk on any risk assessment]
3. challenges of accurate demand forecasting due to limited data available; lack of clarity among stakeholders about new roles, [nobody truly knows who's responsible for what]
4. responsibilities and governance; [crucial for any ICS to function]
5. stakeholder engagement challenges; staff recruitment and retention;
   limited estates accommodation to enable co-location of teams; and 
6. IT systems interoperability impeding implementation.

Notes: The limited estates accommodation needed to re-locate hospital services into has been the main reason for failure of most STP. The original idea was to partner with local councils and have the council provide empty spaces/buildings for the clinics. 

The lack of available and suitable accommodation may result in an ICS refusing to proceed.

If a non-evidence based PACS does proceed, it is likely local hospital services transferred into community clinics will fail, with the hospital or most of its assets sold.

If there is a lack of staff at the vanguard stage then any attempt at a larger system footprint -wide rollout could end in disaster. 

According to the results: there would be a shortage of staff to look after and treat patients, and with no estates available, there would be nowhere to treat them. There would also be no IT network in place and little if any access to patient data.

Related Links

More flaws exposed in ‘integrated care’

The two-year Salford PACS evaluation report can be read in this PDF