Next Steps on the NHS Five Year Forward View and Accountable Care Organisations

NHS England and other national bodies published the Five year forward view for the NHS in England in October 2014, setting out a 5-year plan for the NHS and how it could respond to changing health needs. In the plan, NHSE highlighted funding challenges and outlined a proposed shift towards integration.

In March 2017, NHSE and NHS Improvement (NHSI) published Next Steps on the NHS Five Year Forward View which reported on progress in the 5 years since the Five year forward view and outlined the ‘next steps’ for the NHS, stating: ‘The NHS Five Year Forward View set out why improvements were needed on our triple aim of better health, better care, and better value. This Plan concentrates on what will be achieved over the next two years, and how the Forward View’s goals will be implemented.’

Next Steps outlined the following priorities for the NHS in 2017/18:

• delivering financial balance across the NHS
• improving A&E performance
• strengthening access to GP and primary care services
• improving cancer and mental health services.

Responses to Next Steps

The thinktanks the King’s Fund, the Health Foundation and the Nuffield Trust praised the focus in Next Steps on integration between the NHS and local authorities. However, the organisations' responses expressed doubts regarding the feasibility of achieving ambitions to improve services without increased government funding for the NHS.

Integrated care: STPs, ACSs and ICSs

The Five year forward view had focused integrating services – both within the NHS and across health and social care – through ‘new partnerships with local communities, local authorities and employers’. NHS Shared Planning Guidance in December 2015 then asked these local health and care systems to jointly create 5-year, ‘place-based’ Sustainability and Transformation Plans (STPs) to implement the changes set out in the Forward View.

In Next Steps, NHSE began referring to sustainability and transformation ‘partnerships’ rather than ‘plans’ but continued using the acronym STP. Next Steps also announced that STPs could ‘evolve’ to become Accountable Care Systems (ACSs) in return for greater autonomy, identifying nine STPs (out of a total of 44 STPs in England at that time) likely to become ACSs.

Later, in June 2017, NHS Chief Executive Simon Stevens confirmed the first eight ACSs at the NHS Confederation conference. ACSs were then rebranded in February 2018, when NHS England and NHS Improvement stated in planning guidance that they would now use the term Integrated Care Systems (ICSs) for 'both devolved health and care systems and for those areas previously designated as ‘shadow accountable care systems’'.

In January 2019, the NHS Long Term Plan stated the expectation that ICSs would cover the whole country by April 2021.