The Department of Health’s integrated care “pioneers” will be monitored centrally to check progress against their plans and could be stripped of their status if they lose their way, health minister Norman Lamb has said.
The care and support minister made the announcement in an interview with HSJ last week as he revealed the 14 sites across England that will become the DH’s integration pioneers.
Although the 14 vary in approach, many emphasise preventative care, particularly for the frail elderly. Several seek to create either a single access point for patients, or a multi-agency response unit to deal with emergencies. Almost all make explicit reference to joint working across health and social care.
Information supplied to HSJ by the DH on each pioneer scheme lists NHS England’s local area teams, which commission primary care and specialised services, as an active partner in only one scheme.
Despite many commissioners adopting innovative forms of contracting in a bid to join up services, the only such example listed by the DH is the ambitious plan in Staffordshire to commission integrated cancer and end of life services on “prime provider” contracts lasting to 10 years.
Also notable is the absence of involvement of any of the Shelford group of trusts – the 10 most powerful trusts in the NHS.
The DH’s 14 integrated care pioneer sites are:
- South Devon and Torbay
- North West London
- Waltham Forest, East London and the City
- South Tyneside
A full list of organisations involved in each pioneer bid, and a short description of their plans, can be found here.
Mr Lamb said the 14 were leading a “quiet revolution” in the delivery of health and social care in England. He said the DH would be monitoring their progress, adding that he would remove them from the programme if their projects failed on their own terms.
“You can’t be held up as a pioneer, or as a leader and one that’s influencing others if actually the leadership has dissipated or if the objectives they set themselves aren’t being met,” he said.
Mr Lamb told HSJ the 14 chosen had been identified as “real leaders” in driving integration, and that together they represented an opportunity to inform the rest of the system about how it can be practically implemented.
Disseminating their learning across the NHS would “literally be critical to the rest of the system” as other areas designed their plans for spending the £3.8bn integration fund, he said.
Although the pioneers will not be given any special legal status or protection from competition law, Mr Lamb said he would keep a “watching brief” on these issues.
He did not rule out further legislation to ensure local attempts to integrate care were not scuppered by the Competition Commission. Asked whether he would change the law on competition, Mr Lamb said: “We have to avoid frustrating the development of joined up care for the benefit of the patient… let’s see what happens.”
He added: “We need to monitor this very closely. We must not allow a purist view of competition to frustrate what we collectively know needs to happen.”
Pioneer status was set to be awarded to a 15th site, in west Norfolk. However, the DH decided against the bid after Queen Elizabeth Hospital Foundation Trust in King’s Lynn was placed into special measures.
Emma Stanton, chief executive of the Beacon UK consultancy, which promotes integrated commissioning for mental health, said: “Although there is very little direct mention in all but one of the pioneer sites of improving care to people with mental health problems, it would be good if the 14 could use this as an opportunity to better integrate physical and mental health services.”
She added: “It would also be good to see some of these health economies using their pioneer status as a catalyst to develop new innovative partnerships… including those beyond the boundaries of the NHS.”