Accept Accountability arrangements will be critical to ensuring all Modern Service Frameworks drive meaningful and sustained improvement. NHS England and DHSC recognise this as essential to effective implementation and will be working closely as the detail of arrangement develop with the National Quality Board to ensure arrangements align with existing accountability approaches. These arrangements will need to strike the right balance between assurance and support, ensuring systems are held to account while being given the tools, guidance and resources required to deliver the MSF successfully. The MSF will provide a clinically-led, evidence-based framework to support sustained improvement in patient and carer outcomes, including narrowing inequality and reducing unwarranted variation. The interim update written ministerial statement, sets out how we will drive and sustain the required changes in practice and behaviour across the system. As part of this, areas of action have been identified for those commissioning and delivering services with associated performance and outcome metrics to support system accountability. It complements the existing statutory guidance and service specifications by bringing together evidence-based areas of action, outcome measures and system-level levers into a single coherent framework, to support sustained improvement over time. Metrics (in development) will build on the 2029 aims set out in the Neighbourhood Health Framework to increase the number of people identified as approaching end of life by 10%, and reduce non-elective admissions and hospital bed days by 10%. There will be a notable shift towards outcome measurement. Overall, the performance and outcome metrics will support system accountability and will measure what matters most to people receiving care, and to their families and carers. Measures included will cover all ages, with a focus on unwarranted variation and health inequalities, and a commitment to developing person-centred outcome and experience measures. Additionally, in line with the strategic commissioning framework, we expect all ICBs, to complete an integrated needs assessment, to gain a detailed understanding of their current and future population, including those with palliative care and end-of-life care needs. This is vital in order to commission the services to best meet that need, whilst providing the best value for money. We will be refreshing the statutory guidance and service specifications later this year, to further support ICBs to commission using a system-wide approach across primary and community care, the voluntary sector and social care, and acute hospitals for all patients, including babies, children and young people (BCYP).