Put integration of care at the heart of NHS reform, says The King's Fund

The opportunity provided by the NHS White Paper to encourage more integration of care and improve outcomes for patients should not be wasted, a new report, Clinical and service integration: the route to improved outcomes, from The King's Fund says.

Clinical and service integration should be at the heart of moves to reform the health service but the changes must ensure that the new structures, funding and regulatory framework allow integrated services to grow, rather than stand in the way of their evolution.

The findings of the report

The report argues that GP consortia could form the vanguard of moves to integrate services. As the lead commissioners in the future, GPs are well-placed to use their control over budgets to provide a wider range of services in the community and better meet the needs of patients, but this needs to be done transparently, working with other professionals, to avoid conflicts of interest.

The report draws on examples of the successes and limitations of integration in the UK and abroad. It suggests that greater integration of primary and secondary care and health and social care could improve patient experience and outcomes as well as provide better continuity of care than a more fragmented service. The report also shows that integration is seen to work best when ‘form follows function’ – where teams and services come together in a local area to provide a more co-ordinated service, from which larger scale integration could evolve over time.

Professor Chris Ham, Chief Executive of The King's Fund and lead author of the report, said:

'We know that greater integration of care can be better for patients – their experience of the health service is more positive and their outcomes improve. As such, the work that has been done to achieve closer integration in the NHS should continue.

'While there is no doubt that it will be challenging to make sure that competition and integration work alongside each other to deliver the right benefits for patients, it should not prove an impossible task. Both have an important role to play in the new system.'

Examples of good practice

One of the examples cited in the report is Torbay, where integrated health and social care teams aligned with general practices were set up and where, in 2005 they established Torbay Care Trust, an integrated care organisation, which has built on the work of the integrated teams.

The teams focus on making it easier for patients to navigate all the local health and social care agencies they may encounter. Recent analysis has revealed positive results: Torbay has the lowest use of hospital bed days in the region and the best performance in terms of length of stay.[5] Patients have also rated their experience highly, ranking it highest in the south west for the proportion of people reporting confidence with NHS services.[6]

Read the report: Clinical and service integration: the route to improved outcomes

Notes to editors: 

  1. For further information or interviews please contact the press and public affairs team on 020 7307 2585. If you are calling out-of-hours, please ring 07584 146035.
  2. Clinical and service integration: the route to improved outcomes was published on Tuesday 23 November 2010.
  3. In this report  the term ‘integrated care’ is broadly used to describe the processes of bringing together organisations and professionals in primary and secondary care, as well as those working in the health and social care sectors with the aim of improving outcomes for patients.
  4. Torbay Care Trust is an integrated health and adult social care organisation, responsible for buying and commissioning care in the Torbay area. The Care Trust was formed as a result of historical partnership working and coterminous boundaries between the council and the Primary Care Trust.
  5. Ham C (2010) Working together for health: Achievements and challenges in the Kaiser NHS beacon sites programme. Birmingham: Health Services Management Centre
  6. From an Ipsos Mori survey cited in the above report.
  7. 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 to 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.