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Report warns of obstacles to health integration

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Progress on health and social care integration has been hampered because of a previous focus on competition between services and waiting-list reduction, according to a joint report from The King’s Fund and Nuffield Trust.

Authors Judith Smith, Nuffield Trust head of policy, and Chris Ham, King’s Fund chief executive, warned that the GP-led clinical commissioning groups being created as part of the government’s reforms would  also struggle to integrate services unless policymakers provide them with more help.

They identified policy objectives of competition, rather than collaboration; a disinclination among acute hospitals to seek community care options; and “relative weakness” among commissioning organizations as particular concerns.

Based on a survey of PCTs and case studies the authors found that despite managerial commitment to integrate care, examples of situations in which commissioners had driven change were rare.

They said new approaches to commissioning for integrated services should be tested out, including revisiting the split between service commissioners and those that provide care, with groups of GPs and specialists given a budget to plan and deliver more integrated care for their local communities.

Dr Smith said the drive to cut waiting times and for planned care through competition had inadvertently put barriers in the way of developing services that would improve care for people with complex long-term conditions, and those who need intensive end-of-life support. “If the new generation of clinical commissioners is to do better than their PCT forbears, the government will need to craft an environment in which hospitals and GPs are encouraged to work collectively to shape new forms of high-quality care for a particular population and face greater penalties for failing to do so,” she said.

Prof Ham, pictured, said the government had to ensure Monitor and the NHS Commissioning Board supported both competition and integration, and that the right incentives were created to make the latter happen.

“Payment by results was designed primarily to support choice and competition in relation to elective care at a time when the NHS budget was growing significantly,” he said.

“Alternative forms of payment are required to support integrated care, especially for people with chronic diseases and to support more coordinated unplanned care, when funding is very tight.”

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