Lamb fleshes out NHS integration pioneer plans
Elliot Bidgood, 5 November 2013
In an interview on Friday with the Health Service Journal, Care Minister Norman Lamb outlined more about the plans he announced in May for “integration pioneers”, which will seek to forge ways to bring about service integration. Up until now, only Torbay and handful of other localities have provided working case studies, and the wider applicability of these few examples has been debatable. Each of the 14 pioneers has outlined specific plans, which HSJ’s David Williams noted “overwhelmingly stress” the integration of NHS services with council-run social care, rather than just breaking down silos within the NHS itself.
These organisations will be funded from the government’s new £3.8bn integration fund. Two pioneers, Torbay and Greenwich, are moving towards establishing “accountable care organisations” (ACOs) – these are an idea that originated in Barack Obama’s Affordable Care Act, intended to make government-funded Medicare treatment for America’s over-65s more seamless and cost-effective.
They involve unified multidisciplinary organisations managing all of their assigned patients’ healthcare needs, funded from the centre in exchange for meeting a set of stringent conditions. If implemented successfully here, they will be a powerful example of the NHS successfully innovating based on foreign examples.
Data sharing will also be specially enabled by NHS England, in order to further disseminate best practice. Lamb also briefly alluded to concerns that competition law could thwart integration, saying “We have to avoid frustrating the development of joined up care for the benefit of the patient”. Under the right rules, competition can drive integration, as reportedly occurred in Maastricht with diabetes care for example, but as I wrote in October, the government must strike the correct balance.
Lamb also appears to have made clear that the pilot areas will be measured firmly against the criteria they laid out in their plans – there will be a ‘zero tolerance’ approach to failure, with the removal of pioneers from the scheme if they fail to perform. This is intended to create consistent pressure on the organisations to break through barriers and drive forward plans. It could perhaps also protect patients and taxpayers from the costs of failure. Cost reduction and improving patient care have been key aims of integration, but last year when Ernst & Young and Rand Europe reported on a previous 16-area integration pilot scheme launched in 2009, they found that although doctors and staff felt that care had improved and planned admissions had fallen, satisfaction among patients had also dropped and “no significant impact” was made on overall costs.
Nevertheless, despite inevitable issues, there is overall much to be encouraged by in the government’s integration plans, which are a badly-needed attempt to correct longstanding practices of siloised working in health and social care.
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