Opinion

Accountable care and integrated systems – don’t be fooled

By Zoe Bedford

A large part of our daily business is advising clients on how to address key strategic challenges and market shifts facing health and care organisations in the UK.

One of these recent shifts is towards Integrated Care Systems (ICSs), the re-branded Accountable Care Systems (ACSs), which themselves evolved from Sustainability and Transformation Plans (STPs).

The continual ‘rebranding’ of these emerging systems is baffling to many. An ICS is not the same as an Accountable Care Organisation (ACOs). An ACO is a fancy name for an area that has segmented their population, designed outcomes for these based around the triple aim (improved population health, quality of healthcare and financial sustainability), and agreed some kind of finance pooling to achieve these outcomes. Add that to the growing noise and confusion in the media about their purpose and ownership, reports of legal challenges and a powerful anti-privatisation lobby. This noise is distracting attention from the significant shift to whole-system-led health and care with the aim of delivering care which is less fragmented and better placed to the deliver the triple aim.

It was never intended that the ten NHS England “sponsored” ICSs would be the sole vehicles through which this transition would occur, and over the last six months we have visited a number of lesser-known programmes in the UK and US which show that the shift is happening, irrespective of media and political mythology. There are pockets around the country where teams are quietly getting on with the complex task of integrating services across health and care, such as down in Croydon.

Given that any issues encountered by the ICSs are picked over by commentators and detractors, you can hardly blame the ‘fast followers’ if they’re keeping their heads down and going about their business quietly. The good stuff happening is less often surfaced (take a trip to Kent for example) so it is understandable that many other operators in health and care are confused as to whether this latest push for integration is going to amount to anything.

We are seeing many parking the move towards accountable care in the ‘come back to at a later date’ folder, whilst they carry on business as usual. We believe that this is likely to be the wrong strategy. Whilst the main focus may be on short-term targets and priorities we recommend all organisations quickly get up to speed on the changes that are happening in the NHS as they may quickly see markets shape or reform. They need to be ready to respond to this when it reaches their line of business.

For NHS suppliers or organisations that are heavily involved in the delivery of NHS services, these developments stand to have a number of effects on how they relate with the NHS and their key customer group, and it would be short sighted to not take it seriously. And as for the other argument that a change in government will halt all this; well, that’s another distraction. Irrespective of what happens at No 10, the horse has already bolted. This shift towards integrated care is an NHS England initiative, not a political one and as such has a momentum of its own.

ZPB runs workshops for organisations looking to understand the changing NHS and are hosting a breakfast briefing on this topic on 26th February. Please contact Daniel.chapman@zpb-associates.com if you’d like to join it.