Accountable care systems (ACSs)

In 2016, NHS organisations and local councils came together to form 44 sustainability and transformation partnerships (STPs) covering the whole of England, and set out their proposals to improve health and care for patients.

In some areas, an STP will evolve to form an accountable care system (ACS), a new type of even closer collaboration. In an ACS, NHS organisations, in partnership with local councils and others, take collective responsibility for managing resources, delivering NHS standards, and improving the health of the population they serve.

Local services can provide better and more joined-up care for patients when different organisations work together in this way. For staff, improved collaboration can help to make it easier to work with colleagues from other organisations. And systems can better understand data about local people’s health, allowing them to provide care that is tailored to individual needs.

By working alongside councils, and drawing on the expertise of others such as local charities and community groups, the NHS can help people to live healthier lives for longer, and to stay out of hospital when they do not need to be there.

In return, ACS leaders gain greater freedoms to manage the operational and financial performance of services in their area. They will draw on the experience of the 50 ‘vanguard’ sites, which have led the development of new care models across the country.

First wave of ACSs

NHS England confirmed the first wave of accountable care systems (including two health devolution deal areas) in June 2017. Together, these systems serve around one in six people in England. The accountable care systems are shown below:

A map showing accountable care systems in England

  • Bedfordshire, Luton and Milton Keynes
  • Blackpool and Fylde Coast
  • Buckinghamshire
  • Dorset
  • Frimley Health and Care
  • Greater Manchester (devolution deal)
  • Nottinghamshire
  • South Yorkshire and Bassetlaw
  • Surrey Heartlands (devolution deal)
  • West Berkshire

What will happen next?

The first wave of ACSs are already assuming accountability for local operational and financial performance. From April 2018, they will begin to gain new financial flexibilities and to use new tools for better understanding local health data.

Further ACS areas will be confirmed by NHS England and NHS Improvement in 2018. To become an ACS, a local health and care system must show its partnership is advanced enough to make shared decisions, improve services for the public and manage resources collectively.

Find out more

Take a look at the Next steps on the NHS Five Year Forward View.