Ministers are planning to support a series of large-scale integrated care “experiments”, which could result in a movement away from payment by results, HSJ can reveal.
The project to enable services to be brought together in health economies, beginning in the first half of next year, was discussed last week when health minister Norman Lamb convened a round table meeting at the King’s Fund in London. This was attended by leading figures from Monitor, the NHS Commissioning Board, local government and patient groups.
Mr Lamb told HSJ he wanted to encourage local areas to set up integrated systems, and to ensure that the Department of Health “facilitates” any such attempt.
King’s Fund chief executive Chris Ham, who attended the meeting, said this could involve explicitly allowing health economies to devise their own payment systems so they moved away from payment by results. The centre could also play a role supplying practical support, or in providing assurances that Monitor will not act to break up collaboration on the grounds that it is anti-competitive.
By spring next year, he expects the DH to set out how it will enable changes to payment systems and regulations to be made, possibly taking bids from interested areas and “designating” around 10 places to proceed.
Mr Lamb is keen to enable local “experimentation” rather than dictate how integration should be done. “We will move quickly to give clear guidance to people about how they can best deploy their skills to make it happen,” he said.
“If a group of primary care, secondary care and social care partners say that with a capitated budget approach they can create incentives to maintain the health of the population better, to reduce the number of people unnecessarily going to hospital, the system ought to be able to allow that to happen.”
Mr Lamb is keen to avoid a lengthy process of piloting and then rolling out integrated systems. “I don’t think it has to take ages,” he said. “[We must] get across the message to the whole system from the centre that this is enthusiastically embraced and encouraged.”
Despite fears that Monitor’s duties as an economic regulator could force it to break up anti-competitive integration, Mr Lamb said the body’s leaders are committed to the plans. Monitor “is not going to be a zealot promoting competition for its own sake,” he said.
Mr Lamb also added that the commissioning board’s mandate gives it an “obligation” to drive integration “at scale and with pace from April 2013.”
“I don’t imagine for one minute that this will be the case, but if they were to just see this as only a marginal activity [the board] would be completely misinterpreting the mandate,” he added.
Professor Ham said: “So far commitment has been far too generic. [But] Norman wants to be the minister who makes it happen.
“What has also changed is [new health secretary] Jeremy Hunt as well… together they give all of us much greater confidence that the commitment we have had on paper is going to happen on the ground.
“[Previous health secretary] Andrew Lansley was much more committed to competition, although he also spoke about integrated care. Jeremy Hunt doesn’t have a commitment to the previous set of reforms.”