News / Accountable care offers stepping stone to better NHS (Convergence 2017)

Professor Ham (pictured) said there was no appetite for a top-down reorganisation of the NHS in England, despite it being more complex and fragmented than at any time in his 42 years working with the service. 'Sustainability and transformation plans are a work-around to a top down reorganisation,' he told the conference. 'That's also what ACSs and ACOs are all about. The King's Fund has been arguing for a move to a place-based system of care – a move away from  focusing on organisations to focusing on systems. 'They are the best opportunity to make sense of what we have, particularly with continuing austerity,' he said.

But he acknowledged that this was difficult, particularly as statutory organisations are being asked to work in non-statutory systems and because regulators have been slow to adapt to a system approach.

He said that STPs had 'got off to a difficult start' and had 'a lot of ground to make up' – partly as a result of changing guidance and ambitious deadlines.  However he was confident it was the right approach, based on evidence of integrated systems such as Kaiser Permanente and InterMountain Healthcare in the US and Canterbury Health Board in New Zealand delivering improvements in outcomes and constraining or reducing costs over a long period.

He said there was no single model that could be taken off the shelf and applied in different health economies. 'ACOs come in many shapes and sizes,' he said. 'There is no single model and there is no best model. What works in Morecambe Bay won't work in Frimley. They need to be made in each place.'

However there are some common ingredients. ACOs tend to have responsibility for defined populations, aligned incentives, accountability for outcomes, good IT and ideally a common electronic record, and can identify the parts of the population most at risk while managing care for the whole population.

But he added that success was more related to sociological issues - relationships and leadership - than technical aspects. The ingredients he said were 'necessary but not sufficient'. And he called on local health economies to challenge barriers to progress, including those posed by the legislative framework and the regulatory system.

While STPs, ACOs and ACSs were 'no panacea', Professor Ham said they did 'offer the best hope of making sense of the [current] complexity' proving a 'stepping stone in the right direction'. He acknowledged it was difficult as local areas were 'swimming against the tide of current statutory arrangements. 'But you've got to work with it and find a way forward,' he said.