The evolution of the concept of ‘accountable care’ across the NHS continues to attract a huge amount of comment. From confusion over names – is it ‘accountable care’ or ‘place-based care’? an accountable care organisation or an accountable care system? – to the impact of competing NHS agendas and pressures, the subject is rarely out of the headlines for the health sector. It is now three years since ‘The Five Year Forward View’ introduced the concept of new models of accountable care into the NHS, and six months since ‘The Next Steps on the Five Year Forward View’ shifted the focus of accountable care from sustainability and transformation partnerships (STPs) to accountable care systems in what was described as a continued move away from a ‘fragmented system that passes people from pillar to post’.

Against this backdrop, last month we convened our second roundtable discussion in Manchester to bring together a group of providers, commissioners and think tanks to share experiences and discuss the extent to which the objectives of accountable care could be delivered within the NHS, the challenges to its development and the enablers of further evolution.

It was clear from the discussion that there is still considerable optimism and enthusiasm surrounding the development of accountable care systems as a means of delivering more integrated place-based care. However, for those systems to be implemented and the benefits to be achieved there was a strong sense that there should be less focus on the ‘how’ and more on the ‘why’. Our attendees were in agreement that a fundamental objective of accountable care is agreeing a unified definition of health outcomes that commissioners and providers will be accountable requiring:

  • a common vision among organisations based on the ‘why’ not multiple variations of ‘what’
  • alignment of views on the ‘population’ to be covered

After clarity of vision and purpose, leadership and culture came high up on the list of enablers of further evolution. Strong inspirational leaders, with the time and authority to act as leaders, remain vital to the success of accountable care.