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Accountable Care Systems (ACOs and ACSs)

At around this time the concept of accountable care organisations started to gather pace. The idea was to have one organisation that would have a unified budget and be responsible for the totality of health provision in an area. That organisation would be a “coming together” of health and social care providers with some “tie in” to voluntary sector providers.

Health and Social Care communities started planning for Accountable Care Organisations (ACO’s) with plans by which they would go live in shadow form for the first year. Legal teams were engaged nationally to draft a legal form for ACOs that would bind them together in a common purpose with a common accountability. However it quickly became apparent that this would require changes to statute. The existing structure of the NHS was defined by the Health & Social Care Act 2012 which created NHS Trusts, CCGs and NHSE. These could not be force fit into the new ACO concept.

The language was then changed to Accountable Care Systems (ACS) away from the concept of one organisation towards a system of separate legal entities. Plans were made to establish shadow Accountable Care Systems. All of this was played out locally in Morecambe Bay.

The death knell to the Accountable Care Organisation / System concept was that a major change in legislation, so soon after the Health & Social Care Act of 2012, could not be forced through parliament with no workable majority. Change may come but only if the government of the day has a sufficient majority to be confident of getting the legislation through parliament.


Preston Office

Consortium of Local Medical Committees
Ambulance Headquarters
449-451 Garstang Road

Tel: 01772 863806


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