Second wave of 'accountable care systems' delayed

The ACS programme will go ahead in the coming months but probably under a new name – most likely removing “accountable care” and instead using “integrated” care, HSJ understands.

Several areas of the country that have been in discussions to be designated in a second wave of ACSs were initially told decisions would be announced by early 2018. They have now been told this has been delayed, according to senior figures in several of these areas.

They have not been given a revised timetable but some have been told to anticipate an announcement in April or May.

NHS England said it had never fixed a date for an announcement so it has not been delayed.

It is not known which areas have been selected for the next wave but those which have been under consideration by NHS England include north Cumbria, south east London, Suffolk and north east Essex, and west Yorkshire and Harrogate.

Eight areas were named in June 2017 as shadow ACSs and have been working on the model in 2017-18 with a view to being formally designated for 2018-19. NHS England described the programme as “the biggest national move to integrated care of any major Western country”, and at the time said another two areas may join “later in the year”.

Some of these areas are expected to be asked to manage “whole system” financial control totals from April.

Although most opposition to “accountable care” has focused on the accountable care organisation contract – which is the subject of two judicial review cases – the debate has also an impact on ACSs. The Commons health committee will hold an inquiry into sustainability and transformation partnerships, ACSs and ACOs in February and March.

NHS England has said the ACO contract will not be used until a consultation has been carried out, and stressed that only a small number of areas are close to deploying it.

In contrast, the ACS programme is expected to be taken forward, spreading across much of England, but the systems are likely to be given a new name, focusing on “integrated” rather than “accountable” care. The upcoming 2018-19 planning guidance will explain the next steps.

A leader in one of the areas in discussions about becoming an ACS said it was progressing with integration and system working, but was hoping for the vote of confidence and support that would come with national designation.

An NHS England spokesman said: “It’s great people are keen to get cracking but we have not given a date for an announcement on the next wave of integrated care systems so it is completely wrong to claim that they have been delayed. The planning guidance about to be issued will be clear on next steps.”

In its statement about the ACO contract consultation last week, NHS England said ACOs were “not the only or main way to integrate services… Most areas are seeking to do so through voluntary, non-contractual partnerships where GPs, hospitals, commissioners and local government collaborate to improve services for their population. NHS England will be announcing the next wave of these collaborative partnerships shortly.”