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Transforming the delivery of health and social care

The case for fundamental change


The UK has the second highest rate of mortality amenable to health care among 16 high-income countries, and evidence shows that variations in health outcomes between social groups are widening.

This paper (the first in a series on the future of health and social care in England) explores how the current health and social care delivery system has failed to keep pace with the population's needs and expectations. It argues that incremental changes to existing models of care will not be sufficient in addressing these challenges and that a much bolder approach is needed to bring about innovative models that are appropriate to the needs of the population and are high quality, sustainable and offer value for money.

Key findings

Services have struggled to keep pace with demographic pressures, the changing burden of disease, and rising patient and public expectations. Too much care is still provided in hospitals and care homes, and treatment services continue to receive higher priority than prevention.

  • The traditional dividing lines between GPs and hospital-based specialists, hospital and community-based services, and mental and physical health services mean that care is often fragmented and integrated care is the exception rather than the rule.

  • Current models of care appear to be outdated at a time when society and technologies are evolving rapidly and are changing the way patients interact with service providers.

  • Care still relies too heavily on individual expertise and expensive professional input although patients and users want to play a much more active role in their care and treatment.

Policy implications

National and local leaders need to take a strategic view rather than focusing on short-term fixes designed to preserve existing services.

Implementation of new models of care will involve: decommissioning outdated models of care; supporting NHS organisations to innovate and adopt established best practices; recognising the potential of new providers as an important source of innovation; developing a culture that values peer support for learning and innovation; encouraging players at the local level to test new models of care.