Accountable Care Systems (ACSs)
Last Updated: March, 2019

Accountable Care Systems (also known as  Integrated Care Systems (ICSs) ) are built upon (or developed from)  Sustainability and Transformation Plans (STPs) . ACSs are partnerships between  Clinical Commissioning Groups  and providers such as NHS Trusts, GPs and community health care providers within a regional footprint.

The 'footprint' of the 'Northern Region Integrated Health Care System'

In theory, the health commissioners and providers within a given footprint are expected to work together:

  • Setting up collective decision-making and governance structures.
  • Sharing their workforce and facilities, where appropriate.
  • Agreeing how to share risk and gain.
  • Agreeing a performance contract with  NHS England  and NHS Improvement to deliver rapid improvements in care and performance.
  • Managing funding for a defined population through a System Control Total.

As mentioned above, ACSs are an evolved version of a STPs, with responsibility for the health and resources of a defined population, but ACSs are also an intermediary step towards  Accountable Care Organisations (ACOs)  which are a central component of the  Five Year Forward View  and  NHS Long Term Plan .

Other Concerns

  • ACSs are being introduced without adequate public involvement or meaningful consultation, and without Parliamentary scrutiny.
  • ACSs are being imposed in a context where NHS health care and  social care  services are seriously underfunded.
  • ACSs are being implemented beyond any legal framework, creating problems of governance and accountability.
  • ACSs are being introduced very quickly, with no robust evidence to support their use in the UK context.
  • ACSs increase the potential scope of NHS  privatisation  by laying the ground for ACOs. With an ACO the multiple smaller contracts will be replaced by a single  Integrated Care Provider Contract  to be awarded to a lead provider who will control health and social care services for an entire footprint. In turn this will attract bids from multinational corporations - that of course is the point!
  • ACSs are largely funded by capitated payment arrangements, such as a whole population budget (a fixed payment to be shared between all the ACS partners in order to provide specified services for a defined population, for a set period of time). Each regional footprint becomes like a separate mini health system. This means that money is not pooled to serve the health system as a whole. In turn this becomes another tool to force compliance with spending cuts - and that dovetails with the next point.
  • ACSs incentivise rationing of services and denial of care. Even if there are minimum standards in place, capitated payment will tend to raise the threshold at which patients are offered treatment, irrespective of the care needed. So ACSs are fundamentally at odds with social solidarity and the values of equity and universality that underpin the NHS.
  • ACSs entail 'transforming' the NHS workforce, replacing experienced clinicians such as doctors and nurses with technologies and introducing new, lower skilled roles, such as physician and nurse associates.

ACSs carve up the NHS into segments ready for corporate takeover. They are the consolidation of privatisation carried out by stealth without legislation, dovetailing with the massive programme of cuts and closures (see  efficiency savings ).

Also see  Big Picture - Post 2012 NHS Plans