Commissioners should be able to override current payment rules and share budgets with local authorities in order to accelerate service integration, according to the NHS Future Forum.
The forum has published its second set of reports today, looking at integration, public health, education and training, and information. This follows its initial report last June, published following the government’s “listening exercise” on the health bill.
Today’s report on integration sets a series of deadlines and expectations to encourage more integrated care.
It says all NHS commissioners and local authorities should consider shared budgets for some patient groups and says commissioners should be allowed the freedom and flexibility to vary tariffs and contracts to aid integration while new funding models are developed.
In addition, it calls for further explanations of how NHS competition rules will work.
The report criticises “structural change prescribed centrally” for getting in the way of service integration and warns the NHS Commissioning Board against an overly top-down approach.
The government has accepted all the Future Forum’s recommendations. Health secretary Andrew Lansley will announce that patient experience measures designed to reflect integration will be placed in the NHS outcomes framework.
The government will comment in more detail on other recommendations today.
The Future Forum integration report, written by GP Robert Varnham and former local authority chief executive Geoff Alltimes, says: “There was almost universal welcome for the current focus on integration in health and social care.
“However, we saw and heard that it is currently too hard to make progress, particularly towards the huge gains promised by joint commissioning by the NHS and local government.
“Enabling more patients to experience a smooth, effective and safe care journey is not simply a matter of trying harder – a number of changes in the system are necessary.”
The report raises concerns about the extent of local autonomy to develop integrated services and the current performance management “grip” on the NHS, a word most associated with NHS chief executive Sir David Nicholson, who is also commissioning board chief executive.
It says: “The greatest current challenge facing the NHS is the need to balance financial ‘grip’ with local ‘freedom’.
“Frontline professionals and managers expressed a desire for greater freedom to design locally responsive services. However, they also described how innovation, clinical engagement and the development of locally sensitive services were stifled by a tendency towards centrally imposed change and micro-management.
“We will watch with interest to see how the NHS Commissioning Board establishes a new way of working, which balances the imperative for local freedom and flexibility with the need to maintain financial control and sustainability.”
The report also identifies “repeated structural change prescribed centrally” at the top of a list of “barriers to integrated care”. The government decided to abolish primary care trusts and strategic health authorities after committing to “stop the top-down reorganisations of the NHS” in its coalition agreement document.
National level forum to support integration and oversee enabling programme of work from 2012.
DH should “urgently” support development of new patient experience measures “across whole journeys of care, and within and between services”, to report against from April next year. This should form part of annual mandate for the commissioning board and outcomes framework.
All commissioners “must fully and properly explore the potential benefits of joint commissioning and pooled budgets in health and social care for key populations”.
Monitor and the NHS Commissioning Board should “urgently” help NHS “understand how competition, choice and integration can work together to improve services… in particular they should explain how this fits with the principles and rules for cooperation and competition and UK and European competition law”. Joint guidance should be published “as soon as possible in 2012”.
Monitor and NCB to signal “as soon as possible during 2012-13” how they will set and police tariffs and currencies, including “a proportionate, transparent and consistent approach to local price variations and adjustments where needed to enable more integrated care”.
NCB and Monitor develop new funding models which support and incentivise integration, including accelerating progress already made on “year of care” funding model.
Commissioners should be allowed the freedom and flexibility to vary tariffs and contracts to aid integration, while new funding models are developed.
Commissioners ensure every patient with long-term or complex needs has easy access to named person or team who acts as coordinating point for all their care.
NHS Commissioning Board guidance should design its guidance “for people not specific diseases”.
Commissioners should contract and monitor providers performance on shared decision-making and self-care.
DH set out how NHS, social care and public health outcomes frameworks will “work together to support collaboration and integration”.
DH, NCB and Public Health England suggest “baskets” of outcome indicators which health and wellbeing boards can use to measure joint aims locally.
NCB to use CCG authorisation process to test CCGs’ “will and capability to collaborate in the design of more integrated systems and services”.
NCB explore best way to improve GP contracts to incentivise integrated care.
NCB and commissioners introduce “interoperability measures” such as efficiency and reliability of admission and discharge processes, patient understanding of their care plan, and patient experience, in contracts.