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Collaboration vital in health reform

Health and social care providers need to collaborate to meet challenges

Louise Prime

Thursday, 02 September 2010

The Nuffield Trust has urged the Government to encourage collaboration as well as competition between health and social care providers so that patients receive high quality and responsive care, in its latest report. The independent charity says that seamless care will only come with a balance of both approaches.

Removing the policy barriers to integrated care in England looks at five English regions in which local clinicians and managers are already working together to break down the barriers between different health professionals and services – Torbay, Nottingham, Redbridge, Trafford, and Cumbria.

The Nuffield Trust says there is already much international evidence that more integrated health care services lead to more efficient, patient-focused care, and believes that the White Paper Equity and Excellence: Liberating the NHS is an opportunity for the NHS to become more integrated and, as a result, deliver higher quality and responsive care at a reasonable cost.

Its report concludes that the White Paper reforms, such as giving GPs real budgets and responsibility for health care commissioning, could potentially deliver more seamless care to patients as long as seven key policy barriers are first overcome. These potential barriers are highlighted in the five case studies examined in the report. They are:

  • GP commissioning should be used to support new forms of care delivery and should, from the outset, actively encourage the involvement of secondary care clinicians alongside primary care teams.
  • The Government should recognise the need for competition and choice in some areas of care and collaboration in others. Competition rules should be developed to reflect this.
  • Policymakers should use incentives, such as enabling capitated budgets, to support the development of integrated care; currently, those for encouraging collaboration and integration are less developed and limited in uptake.
  • As social care funding is going to be even more constrained than health service funding, greater pooling of resources will be required, particularly when caring for frail and vulnerable people who rely on both health and social care professionals.
  • Health regulators Monitor and the Care Quality Commission should encourage integration and be less focused on assessing performance of individual health providers. Regulation needs to be part of a local system of care and focused on patients’ experience throughout the health and social care system, including at key points of changeover.
  • Local leadership will be needed to help the development of integrated care. In most of the case studies this was provided by PCTs, but their proposed abolition makes it vital that policy-makers recognise the importance of local leadership and clarify who will be responsible for this.
  • Clinicians must be involved at all stages in the design and commissioning of services, because integration challenges long-held beliefs about what – and where – services should be delivered.

The report’s author, Nuffield Trust head of policy Dr Judith Smith, said: “Encouraging integration between providers of care is the most rational way forward to reduce fragmented care, the avoidable ill health it produces, and to improve efficiency. Competition does challenge the idea of integrated care organisations but it’s certainly feasible to create a system where there is an appropriate degree of competition between providers, whilst assuring co-ordination of services across general practice, hospital and other sectors.”

Her co-author Professor Chris Ham, chief executive of The King’s Fund, added: “The government must do more to break down barriers to integration through smarter regulation and aligned incentives. Hospital specialists should work alongside GPs in delivering care closer to home.”


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