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The Advancing Quality Alliance (AQuA) is an NHS membership organisation based in the North West of England.  AQuA has extensive experience of supporting member organisations with integration and latterly the development of Accountable Care Organisations (ACO). We will describe the experiences of a number of AQuA members from involvement in the Integrated Care Discovery Community in 2012-14 through to the development and implementation of integrated or accountable care organisations in 2017. We will highlight the practical application of AQuA’s Integrated Care Assessment Framework and the development of a complimentary framework to support ACO implementation.  In particular, we have been working with our members to understand how the interplay between complexity, improvement science, large scale change, leadership and culture can support the successful implementation of integrated/ accountable care and new models of care deliverey.   Through this work we have recognised some emerging themes for successful integration and development of Accountable Care Organisations: robust system leaders able to lead in volatile, uncertain, complex and ambiguous contexts. strong, collaborative relationships between system leaders built on trust a compelling narrative and purpose for their “place” AQuA’s work over the last two years has focussed on supporting system leaders to develop these radically different leadership skills and enabling systems to develop trusting relationships. The experience of several AQuA members who started their integration journey as part of the Discovery Community in 2012 and are now in the process of implementing ACO-type organisations has demonstrated the benefit of sustained support from AQuA.  AQuA has continued to evolve the integration support offer to members and customers based on the learning and outcomes of members across the North West, ensuring the applicability and transferability of this support. Targeted population and stakeholders: The presentation will be of interest to NHS Leaders and clinicians working in Primary Care, Commissioning, Acute hospitals, Mental Health, Community and Specialist services , Social care leaders.

From Integrated Care to Accountable Care, the North West England journey: System leadership challenges and successes.