We know form should follow function, but does that leave a change in behaviour bringing up the rear? The journey towards accountable care can be confusing and convoluted. Firstly, there must be a simpler way. Secondly, we need to make sure we empower residents, services users and staff to engage differently and take control.

“To ACO or not to ACO” that is the question….a conversation with a DASS colleague the other day did prompt some light hearted reflection our somewhat Shakespearian integration journey. It has become an epic (hopefully we end in neither tragedy nor comedy!) and the language of accountable care is such, a Mastermind contestant would struggle with as a specialist subject.

Have we over complicated the move to accountable care?

On one hand, fundamentally transforming a system of this size and complexity is huge. On the other, as with any system redesign, the way in which those choices are presented can affects how quickly progress together is made. De-mystifying the journey can have a really positive impact on developing trusting relationships as emerging system leaders.

Being a Barnsley lass and known for ‘plain speaking’ in conversation with clients, we have found few simple questions have helped teased out the important issues to find a way through this complex, political and emotive agenda:

  • Who is it for?
  • What are we delivering?
  • How will we contract for it?
  • How can providers come together to respond?

Will making providers more accountable make people more responsible?

Fundamentally, if we are unable to work with staff and residents at the heart of services to define the changes they want to make, as well as the changes to the system, we will design a new system that continues to focus its energy on firefighting.

Discussion with Public Health colleagues at a recent session on changing conversations, highlighted that we still have a focus on ‘What the matter with you?’ instead of ‘What matters to you?’

Greater Manchester’s ‘Taking Charge’ programme is demonstrating some fascinating customer insight into the reason for the healthy (or unhealthy) behaviours of the 2.6m people across the region. This insight allows a more focused approach to population health, tapping into a person’s Health ambition. Identifying the motivators and barriers to improving wellness. For example, you can spend fortunes on leisure centres but if mental health and self-worth is at the heart of non-attendance, facilities won’t be used.

Customer and staff insight is critical to changing the model of care to focus on gaining and maintaining independence. Finding ways to support people to take control and be responsible for decisions around their health, well-being and care is an essential element of a sustainable system. The trick will be how to incentivise those who are ‘accountable’ to take it seriously given the likely longer payback period. We are already seeing a rise in ‘social value’ aspect to contracts, and mechanisms such as social impact bonds being used to support organisation work in an outcome focussed way where capital may be an issue. Further expanding this to include a focus on community action and engagement, to demonstrate the incorporation of user involvement in the design and delivery of services, will be a welcome next step in the move to positive behavioural and cultural change. 


Helen Sunderland

Director | National Social Care Lead, LPS