The King's Fund has called for significant changes to the government's health reforms to enable the NHS to provide a 'new model' of care that meets the challenges of the future.
In its response to the government's listening exercise on the Health and Social Care Bill, the Fund says it supports the need for reform but argues that it must be based on a clear diagnosis of NHS performance and the challenges it faces. It calls for the NHS to be re-orientated to deliver a new model of integrated care, based on stronger collaboration between health professionals and more effective co-ordination of services.
The response, Where next for the NHS reforms? The case for integrated care, argues that integrated care offers the best prospect of improving services for patients and addressing the key challenge facing the NHS – demographic change and the increasing number of people with long-term conditions such as diabetes, asthma and dementia. It draws on evidence from the NHS and the United States showing that integrated care delivers better outcomes for patients with long-term conditions and improves the quality of specialist services such as cardiac, cancer and stroke care.
The Fund calls for a number of significant changes to the Health and Social Care Bill and wider health policy to deliver integrated care.
- The role of the new economic regulator, Monitor, should be re-defined to allow them to promote both competition and collaboration.
- All the main bodies involved in commissioning and providing health care should be under a duty to collaborate and required to work towards the goal of delivering integrated care.
- GPs and specialists should work closely together to overcome historic divisions within the medical profession – to help encourage this, new GP consortia must involve a range of health professionals.
- NHS payment systems should be reformed to encourage the delivery of high-quality, co-ordinated care and avoid perverse incentives to increase hospital treatment, as is the case under the current system.
- Regional-level leadership is needed to plan the delivery of specialist services such as cancer, cardiac and stroke care – this could be provided by new 'clinical cabinets' drawn from a wide range of clinicians.
Looking to the future, the response also outlines radical proposals to relax the current purchaser-provider split and enable groups of GPs and specialists to form 'integrated care partnerships' that provide as well as commission health services. It suggests that this approach should be piloted and could be developed over time by taking an evolutionary approach, avoiding the need for further restructuring within the service.
The King's Fund's Chief Executive, Chris Ham, said:
'Integrated health care offers the best prospect of enabling the NHS to meet the challenges of the future. We welcome recent indications that this argument is being heard within government. But moving to an integrated health system requires more than a change in political rhetoric and a few tweaks to the Health Bill – it means making significant changes to health policy to ensure that integration is hard-wired throughout the NHS.'
Read the response: Where next for the reforms: The care for integrated care
Notes to editors:
Where next for the NHS reforms? The case for integrated care is published by The King's Fund on 23 May 2011.
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The King's Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.