The organisations involved include the NHS, local authorities, voluntary and charity groups, and independent care providers.
There are more than 70 performance metrics by which they are judged, grouped into six "oversight themes": quality, access and outcomes, preventing ill health and reducing inequalities, leadership, people, and finances.
[1] Each system is to set their own constitution, determine staff pay and can raise "additional income" but the chair must be approved by the Secretary of State for Health and Social Care.
NHS trusts, clinical commissioning groups and local authorities in the new ACSs were to "take on clear collective responsibility for resources and population health".
[11] The process was denounced by John Sinnott, Chief Executive of Leicestershire County Council in September 2017 as lacking any element of public accountability.
He said that existing models in other countries were interesting but not relevant to democratic accountabilities in the UK since they had different governance structures and forms of service provision.
[14] In February 2018 it was announced that these organisations were in future to be called integrated care systems, and that all 44 sustainability and transformation plans would be expected to progress in this direction.
[17] In January 2019 it was announced in the NHS Long Term Plan that by April 2021 integrated care systems were to cover the whole of England, with a single clinical commissioning group for each area.
They wanted to see ethnic diversity and inclusion a part of every NHS board's core business and that every system should develop a 10-year strategy, with annual milestones, for reducing inequalities.
The consultation said that this was not a new type of legal entity, but merely the "provider organisation which is awarded a contract by commissioners for the services which are within scope."
They warned that without concurrent investment in social care and broader public services, it was “very likely” further reforms would not yield the desired results.