Will NHS leaders rise to the challenge of an integrated care system?

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The argument for integrated care to play a bigger part in the NHS appears to have been won – at least in principle. It was a central recommendation of the Future Forum and has been endorsed by the government in its response to the Forum's report.

At a time when the NHS is facing growing demands from an ageing population in which the burden of chronic disease is increasing, it is self evident that clinicians and organisations should work together to meet the needs of service users and ensure that the right care is provided in the right place at the right time. Just as important, there is now sufficient evidence to show the benefits of integrated care and why it should be given priority in the next stage of reform.

A new briefing from the Fund summarises this evidence and describes examples from around the world. The challenge now is how to make this happen and move beyond isolated examples of good practice.

In rising to this challenge, government must play its part by removing some of the barriers that get in the way of integration. These barriers include financial incentives that reward activity rather than continuity of care, regulation focused solely on organisations instead of systems, and a commitment to promote competition that could potentially make it harder to support collaboration where it will bring benefits.

Equally important is the need for leaders in the NHS, local government and the third sector to take the initiative and promote integrated care. In the current harsh financial climate, there is a real risk that leaders will adopt a fortress mentality in which they focus on the survival of their organisations regardless of the consequences for others. The alternative – and the one that we favour – is to take a whole system perspective and for leaders to work together across a health community to achieve financial and service targets.

The Fund is using its expertise to work with policy makers to create a context that supports integrated care. We are also providing support to NHS organisations in the North West through AQuA, as well as delivering a whole system leadership programme in five health communities in England.

The King's Fund will continue to contribute policy analysis, research and leadership development expertise to encourage and facilitate integration but neither we, nor the government, can deliver it. Making a reality of the vision of a more integrated health care system must rely on the will and commitment of local leaders to take up the challenge.

Chris has also collaborated with the Nuffield Trust on their publication: Commissioning integrated care in a liberated NHS


John Kapp

Comment date
25 September 2011
I agree with Chris' comments, but they don't go very far with a prescription of what government or CCGs should do. I think that they should integrated NICE-recommended complementary treatments by opening up the market to private providers, thereby bringing down the waiting times from thousands of years to 18 weeks.

Janet Kelly

Senior Lecturer,
Staffordshire University
Comment date
30 September 2011
I consider that Chris Ham along with his colleagues are making a very valiant attempt in raising to the fore, once again the issue of poor or lack of leadership and management within the NHS. The debate around the disposal of more administrative staff in the NHS is also a matter of concern.

I teach leadership and management in healthcare in a University and can verify from experience and anecdotally, that at the moment, there is not an integrated approach to care. There is far too much fragmentation currently in the NHS and major disempowerment amongst key clinical practitioners. This disempowerment has eroded a deep sense of self belief amongst clinicians who are often reluctant and anxious about making pertninent decisions about the patients' they care for.

I would like to see a major change in this culture. I would like to think that I can make a difference in what I teach and want to play my part as an experienced clinical practitioner and educator in this empowering of our clinicians to once again contribute much more robustly in the decision making process related to patient care and the management of the NHS


complimentary therapist,
Comment date
07 October 2011
having just returned from a four month intensive study tour of chinese hospitals my eyes have been opened to the huge amount of people treated as outpatients by tuina and acupuncture doctors with whom i spent 6 days a week learning from, the amount of people i witnessed being carried or hobbling in then walking out waving without long term pills or huge waiting lists was astounding. the range of treatable problems is amazing. having so many people maybe the chinese have been forced to use the most effective and cheaper methods of keeping wards manageable and people mobile/working. every hospital there has an "alternative dept" they've been using the same methods for 5 thousand years unchanged. maybe there might just something worth looking at within it? i would love to help this happen and am more than qualified to teach others being uk and china qualified as a "tuina therapist".. it works, i'll prove it to anyone...

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