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Care services minister outlines new integration schemes

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Ministers are planning to support a series of large-scale integrated care “experiments”, which could see a move away from payment by results.

Health reporting HSJ and LGC logo

The project to enable local services to be brought together, beginning in the first half of next year, was discussed last week at a meeting between care services minister Norman Lamb, local government representatives, the NHS Commissioning Board and the regulator Monitor.

Mr Lamb told LGC’s sister title Health Service Journal he wanted to encourage local areas to set up integrated systems, and to ensure that the Department of Health would “facilitate” any such attempt.

King’s Fund chief executive Chris Ham, who attended the meeting, said this could involve explicitly allowing local health and care organisations to devise their own payment systems so they moved away from payment by results.

The government could also play a role supplying practical support, or in providing assurances that Monitor would not act to break up collaboration on the grounds that it was anti-competitive, he said.

By spring next year, he expected the DH to set out how it would enable changes to payment systems and regulations to be made, possibly taking bids from interested areas and “designating” about 10 places to proceed.

Mr Lamb is keen to enable local “experimentation” rather than dictate how integration should be done. “We will move quickly to give clear guidance to people about how they can best deploy their skills to make it happen,” he said.

“If a group of primary care, secondary care and social care partners say that with a capitated budget approach they can create incentives to maintain the health of the population better, to reduce the number of people unnecessarily going to hospital, the system ought to be able to allow that to happen.”

Mr Lamb is keen to avoid a lengthy process of piloting and then rolling out integrated systems. “I don’t think it has to take ages,” he said. “[We must] get across the message to the whole system from the centre that this is enthusiastically embraced and encouraged.”

Despite fears that Monitor’s duties as an economic regulator could force it to break up anti-competitive integration, Mr Lamb said the body’s leaders were committed to the plans. Monitor “is not going to be a zealot promoting competition for its own sake,” he said.

Mr Lamb also added that the commissioning board’s mandate gave it an “obligation” to drive integration “at scale and with pace from April 2013”.

“I don’t imagine for one minute that this will be the case, but if they were to just see this as only a marginal activity [the board] would be completely misinterpreting the mandate,” he added.

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