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Richard Humphries: Councils must be inside the accountable care tent

Richard Humphries
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‘Accountable care’ is the latest policy zeitgeist in the world of the NHS.

Given the patchy engagement of councils in the sustainability and transformation partnership process, local government could be forgiven for being suspicious. Though the term is associated with President Obama’s health reforms, it’s meaning in the context of England’s free-at-the-point-of-use, tax-funded NHS could not be more different.

But there is every reason why local government not only should take a keen interest in development of accountable care but be actively engaged in its development. At its heart, accountable care is about integrating services, with organisations working together not just to treat and support people with health and care needs but tackling underlying causes of illness. Accountable care is about improving the health and wellbeing of the whole population, so it will not work without the wholehearted commitment of local government.

As we’ve described in our recent long-read, common elements of accountable care are a single budget covering the whole population, commissioning based on outcomes rather than activity, and providers collaborating to achieve those outcomes rather than competing for contracts. Accountable care is an attempt to overcome the complexity and fragmentation that resulted from the Lansley reforms in 2013 without another costly and distracting reorganisation. Those on the receiving end of many NHS shake-ups over the years will say amen to that.

There is no single template for accountable care, but different arrangements are beginning to emerge in different places. The contrast with previous reforms that have sought to impose uniform top-down structures irrespective of local circumstances could not be starker. It is no coincidence that places making the most progress, such as Greater Manchester, Northumberland and Nottinghamshire, have featured strong local authority leadership driving the changes. This reflects local government’s natural and longstanding affinity with places, populations and systems; exactly the same focus that NHS England is now seeking through accountable care. Local government brings to the table long experience in public engagement and a history of organisational stability. Securing the buy-in of local elected members can be challenging but is an important success factor.

But accountable care is not a panacea. There are tricky issues arising from the differences between NHS and local government in governance, funding and accountability. There needs to be much more thought about the role of adult social care given its fragile and fragmented provider market. Although accountable care has triggered fears of NHS privatisation, organisational self-protection is a much bigger risk, especially if regulators remain wholly focused on single organisations and not on how well the whole system works for people. Whatever the challenges, this is a tent that local government really needs to be inside.

Richard Humphries, senior fellow – policy, the King’s Fund

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