Claire & Simon's blog: accountable care, the end of the beginning?

Claire & Simon's blog:  accountable care, the end of the beginning?
posted 28 July 2017

Accountable Care, whether articulated in terms of systems, organisations, networks, or any other form of coming together, has been dominating conversations about the future of health and social care in England for some time. And so it was no great surprise when it dominated again at Confed17 in June, with both Simon Stevens and Matthew Swindells robustly making the point - in words of one syllable - that for NHS England, “it is the main game in town”.

Cynics might dismiss it as another fad, another byword for reorganisation, or just the latest top-down intervention in what seems like a never-ending game of more-for-less. However, we will argue that in this instance the cynics might be wrong – and that accountable care is a potential paradigm shift in how we, in the UK, think about ‘care’ in the broadest sense.

So why do we think accountable care is different? For three main reasons: firstly, we think it is “radically evolutionary”; secondly, that it addresses the practical problems of the current service delivery model; and thirdly, that it is about expanding care, not reducing services.

Each of these is a blog post of its own so, for now, we will just start with the first of these, the idea of accountable care as an example of radical evolution.

Why is accountable care evolutionary? Because one of the most interesting aspects of the accountable care model is that it gives us a common language to talk about and start to implement something that we have all been working towards for years – a coming together across the commissioner / provider divide, around the needs of individuals and communities.

There has been increasing recognition that whatever the benefits that came from creating an internal marketplace in NHS services, a failure to combine forces now, to address rising and changing demand, will inevitably sink everyone involved. In parallel, at Confed as elsewhere, there was an increasing recognition of the symbiotic relationship that exists between the health service, local government and the voluntary and community sector: that from how services are planned and delivered, to how they are regulated and funded, finding a joint way forward is as fundamental as overcoming barriers between NHS primary, community and acute care. And if we find a way of addressing all of that, we really will have done something radical.

Progress so far – from “Local Strategic Partnerships” through to the Better Care Programme and the emergence of STPs – has been inconsistent, and fragmentary at best. But new forms of joined-up care are emerging, and the lesson when we look back on this may be that although radical change may take time, that doesn’t make it any less radical, and sometimes make it more likely to succeed.

If so, perhaps the real question is whether, in the ongoing pursuit of the “holy grail” of better integrated, person-centred care, accountable care represents the end of the beginning, or the beginning of the end?