You might have heard the phrases Accountable Care Organisations, Accountable Care Systems, or Accountable Care Partnerships being used more and more during the past 18 months when people talk about the future of health and care services, but what are they and how do they relate to the varied work each of us are doing?
In Cornwall and the Isles of Scilly we have begun to adopt the term Accountable Care Partnership, which I believe is a true reflection of our journey so far. Whilst many people may assume that the NHS is one, an aligned and coordinated health service, it is worth noting that since the inception of the NHS in 1948 it has never been a single entity. There has always been a boundary between those who purchase health care and those who provide it, or in our current iteration between those who commission and those who provide, such as GP practices and hospitals. Whilst we talk about international examples of capitated accountable care, such as in Christchurch, New Zealand, or Valencia in Spain, we have always worked with what is a fragmented system.
What an Accountable Care Partnership sets out to do is bring together accountability for the delivery and performance of services – such as mental health, community hospitals, emergency care or transport – for ourselves. Now that there appears to be very little prospect of an amendment to the 2012 Health and Social Care Act, I fully expect that we will continue to work within current legislature and guidance.
This means that the emphasis of commissioning health and care services will also change – a responsibility which has sat with clinical commissioning groups since 2013. There is a consensus from those behind the thinking of Sustainability and Transformation Plans (STPs or, Shaping Our Future, as we call our programme), that the role of a commissioner will become more strategic in the future. The system performance will primarily become the responsibility of organisations that provide services, which are working towards common aims –the tactical side of commissioning.
As we bring together local NHS and care services, we must remain mindful of what is happening in other parts of the country but it is clear there is no national blueprint as to how we move in this direction. This provides us with the opportunity to develop our own ACP, influenced by our own thoughts. Even in areas such as Dudley where there is a current procurement to develop an Multi-speciality Community Service Provider (MCP), to deliver a range of services including community services; mental health and learning disability services; urgent care centres and GP services and out of hours’ care, this goes nowhere near creating a single provider for all services outside of acute hospitals. Individual GP practices will be working together, as individual providers, around a common population partnership aim. In Manchester, where there have been several hundred million pounds of investment to support devolution, there is no thought process that relies on widespread organisational merger.
The accountable care developments are, in the main, held together through partnership and relationships. We need to remember this during the coming months and maintain our primary focus on achieving improved outcomes for people living in Cornwall and the Isles of Scilly