Accountable Care Systems

As mentioned  on other pages, NHS England (NHSE) has divided the English NHS into 44 local health systems (‘footprints’) and more recently required these to morph into Sustainability and Transformation Partnerships. These are now expected to evolve into Accountable Care Systems (ACSs). In time, some of these will be encouraged to become Accountable Care Organisations (ACOs).

An Accountable Care System is an evolved version of a ST Partnership with responsibility for the health and resources for a defined population. It’s different to an ACO, partly because existing commissioning contracts remain in place. Commissioners, together with a network of providers across different services, enter into an alliance agreement and commit to managing resources together, along with agreeing governance arrangements and how to share risk and gain.

In return for providing ‘joined up, better coordinated care’, ACSs will ostensibly have more control over the operation of the health system in their area. But they will need to share their workforce and facilities where appropriate and create an “effective collective decision making and governance structure” – not easy given that an ACS cant replace the individual accountability of the organisations within it.

NHSE’s ambition is for ACSs to cover half the population of England by 2020, something it acknowledges will be a complicated transition, requiring a staged implementation.

By June 2017, Jeremy Hunt had announced eight ‘shadow’ ACSs: Frimley Health (including Slough, Surrey Heath and Aldershot), South Yorkshire & Bassetlaw (covering Barnsley, Bassetlew, Doncaster, Rotherham, and Sheffield), Nottinghamshire (with an early focus on Greater Nottingham and Rushcliffe), Blackpool & Fylde Coast (with the potential to spread to other parts of the Lancashire and South Cumbria at a later stage), Dorset, Luton (with Milton Keynes and Bedfordshire), Berkshire West (covering Reading, Newbury and Wokingham), Buckinghamshire.

These have, in principle, agreed a draft Memorandum of Understanding (MOU) with NHSE, signing them up to “more assertively moderating demand growth”; meeting quality targets; setting up appropriate governance; and achieving a single financial control system – something the MOU acknowledges will “inevitably be bumpy in terms of its impact on the financial position of individual organisations”.

The eight ACs are also required to form a development group and produce a ‘pathway’ for attaining full ACS status that other ST Partnerships may follow.

[Apologies – this page is still under construction]

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