The NHS healthcare system needs to develop and integrate to respond to the growing burden of chronic illness.
Many NHS researchers, managers and clinical leaders believe that increased integration within the health service will help to achieve this, and the government has made clear its ambitions that the health reforms should encourage integrated care.
This paper addresses the fundamental question of whether competition and integration can co-exist and considers the role that different bodies, especially the NHS Commissioning Board and Monitor, will play within a new system.
The paper argues that, through its influence on commissioners, the NHS Commissioning Board will have an important role in fostering an environment that encourages integration.
The elements of policy design and implementation that may be most critical for fostering development of integrated service delivery include:
- developing bundled payment mechanisms so that commissioners can contract for packages of care from different providers
- allowing flexibility for local innovation – regulations and guidance from the NHS Commissioning Board and Monitor are critical
- access to specialist procurement support for clinical commissioning groups to allow them to exploit flexibilities in procurement rules.
The paper concludes that to create effective integrated care pathways for particular conditions or individual patients the NHS Commissioning Board and Monitor will need to have a shared vision for payment currencies and clear measures of efficiency, quality and outcomes.
In addition, these two bodies will need to create opportunities for experimentation, feedback and learning in their regulations and guidance in order to create conditions in which integrated provider organisations can emerge. Without clarity in policy and in regulation, competition and integration of services will be put at risk.