As part of our new programme on sustainability and transformation partnerships (STPs) and accountable care, this briefing brings together an overview of how national policy has evolved to promote system-based collaboration, including the development of STPs, accountable care systems (ACSs) and accountable care organisations (ACOs).

Key points from the briefing include:

• NHS trusts support the principle of collaboration at the heart of the STP/ACS approach; it provides one solution to the challenges facing health and care by focusing on local system partnerships rather than isolated activity by any single organisation.
  
  
• Trusts are leading, and contributing to, the development of STPs/ACSs, and ACOs across the country and will continue to play a pivotal leadership role in many local areas.
  
  
• Key examples of the changes underway in some areas include the development of more strategic approaches to commissioning, through the merger of clinical commissioning groups (CCGs), integrating commissioning with local authorities and the emergence of ACOs, as well as the integration of services, horizontally and vertically, between providers.
  
  
• However, the pace of change varies considerably across the country largely dependent on whether areas have a history of strong relationships on which to build. We look forward to working with the national bodies to ensure that all STPs receive the support they need to develop, particularly those areas which are progressing more slowly.
  
  
• The national bodies must be clear about the core aims of STPs and ACSs and avoid overloading them, for example, with requests to monitor and deliver new policy aims.
  
  
• We need an honest conversation about how to develop governance and accountability mechanisms which support system-level partnerships and complement the statutory obligations of their component organisation – in the case of trusts, the unitary board. We also need to ensure public engagement and consultation on plans for change.
  
  
• We need to develop a shared understanding about the terms used in relation to accountable care, particularly the definition of an ACO, as set out by the Department of Health (DH) and NHS England. Local partners must be clear about the contractual and partnership models underpinning new and integrated approaches.