Delivering integrated care has to be given the same priority over the next decade as reducing NHS waiting times received during the last 10 years, health policy researchers have told the government.
Integrated care is essential to meet the needs of the ageing population, transform the way that care is provided for people with long-term conditions and enable people with complex needs to live healthy, fulfilling, independent lives, according to a new study produced by think tanks The King's Fund and the Nuffield Trust.
This needs to become the main business of health and social care, and it can be delivered without further legislative change or structural upheaval, they say.
The report follows the Prime Minister's pledge last year to make integrated care one of his five key priorities for the NHS, and the NHS Future Forum's call to "move beyond arguing for integration to making it happen." The King's Fund and the Nuffield Trust were subsequently approached by the Department of Health to feed in ideas for a national strategy on integrated care.
In their report, they argue that integrated care offers an opportunity to improve services for those who need them most and help to deliver the productivity improvements on which the future of the NHS depends. They set out a number of recommendations designed to embed integrated care across health and social care systems over the next five-10 years, including:
- a clear, ambitious and measurable goal to improve the experience of patients needing coordinated care, to be delivered by a defined date;
- enhanced patient guarantees including an entitlement to an agreed care plan and a named case manager responsible for coordinating care;
- reforms to financial incentives so that NHS payment systems reward good outcomes for patients rather than encouraging admissions to hospital;
- clear guidance on how competition will operate in the NHS to avoid perceptions that competition rules are a barrier to delivering integrated care; and
- a programme of organisational development to support NHS organisations and local authorities to make change happen.
The report calls on the Department to articulate a clear and compelling case for change and to create an environment in which NHS organisations and local authorities can deliver integrated care at scale and pace. This, it argues, is essential to overcome a "permission-based" management culture in the NHS that often discourages innovation and risk.
"Integrated care can be delivered without further legislative change or structural upheaval and would be embraced by the professions and NHS staff," said Chris Ham, chief executive of The King's Fund. "It is time to move from pockets of good practice to ensure it is a must-do priority and make it the core business of everyone involved in health and social care," he added.
Nuffield Trust director Jennifer Dixon called on the Department to "create an environment in which integrated care can flourish - this is less about extra spending and more about removing rigidities in the system and encouraging creativity," she said, and asked: "if not now, then when?"
