Developing accountable care systems: lessons from Canterbury, New Zealand
The health system in Canterbury, New Zealand, has undertaken a significant programme of transformation over the past decade. As a result of the changes, the health system is supporting more people in their homes and communities and has moderated demand for hospital care, particularly among older people. Change was achieved through developing a number of new delivery models, which involve better integration of care across organisational and service boundaries, increased investment in community-based services, and strengthening primary care. The experience in Canterbury offers useful lessons for the NHS in terms of how to redesign care in this way. Key approaches include the development of a clear, unifying vision of ‘one system, one budget’; sustained investment in giving staff skills to support them to innovate and giving them permission to do so; and developing new models of integrated working and new forms of contracting to support this. The transformation has taken more than a decade and has required investment, highlighting the challenge of the tight timescales and limited funding attached to current plans for transformation of NHS services.