A turning point in health policy?
Will we remember November 2012 as the month health policy – after two decades travelling in one direction – began to forge a different path? It seems an outlandish claim to make of Norman Lamb’s backing for integrated care “experiments”, but there is some evidence it may prove to be such a turning point.
For a start, unlike much of the recent reforms, it is working with the grain of NHS sentiment. The idea has surfed on an almost unprecedented wave of goodwill ever since HSJ broke the story. Goodwill is the glue which makes policies “stick”.
Crucially the idea has a champion. “Norman wants to make it happen”, King’s Fund chief Chris Ham tells us.
Most tellingly, there appears to be substantive work underway – from the development of a standard commissioning contract which allows for a prime contractor model to the squaring of Monitor to ensure it does not hamper “the experiments”.
Finally, there appears to be a desire to move forward at pace. To, for example, enable those clinical commissioning groups who want to adopt this approach to have the tools as soon as possible.
This does not necessarily signal a move away from competition as a force within healthcare, there is no reason that prime contractors would not be drawn from competing bids. But it might signal the end of the assumption that payment by results would eventually cover the majority of activity and, more importantly, encourage an approach to basing healthcare delivery on a population model funded on a capitated basis.
Local health economies appear to be increasingly finding ways to avoid PbR and contract on a different basis. Those who are doing so – or would like to – will read Mr Lamb’s words and sniff a change in the wind.
There are many questions to answer, notably how the most significant aspect of integration – the inclusion of social care – can be facilitated. There is also every chance the idea may suffer the fate of most other integration policies and see its complexity strangle enthusiasm. However, the majority of HSJ readers will wish this “experiment” succeeds.
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Readers' comments (3)
Anonymous | 22-Nov-2012 10:30 am
I suspect that the most significant barrier will be the integration of primary care.
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Patrick Newman | 22-Nov-2012 12:35 pm
Integration is motherhood and apple pie served up on the trail to the holy grail! However although competition in theory is not incompatible with achieving integration legally enforceable contracts that exist to provide contractors with growing bottom lines is. An exclusive centre of special interest outside the NHS. If the primary contractor is an acute FT does it not becomes a case of "surgeon downsize thyself"!
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Anonymous | 26-Nov-2012 2:22 pm
Not a good collection of oxymoron!
Standard commissioning requires specification and definition of future state. Experiments that are based on this will evidence the hypothesis, irrespective of whether or not it's of any use to anyone. Don't commission for robustness: fail safe - instead manage the emergence of beneficial change: safe to fail.
NOT an engineering paradigm, but a complementary biological system!
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