One of the leading proponents of integrated care has called for the government to go further than its “warm words” made in response to the NHS Future Forum.
The Department of Health accepted all of the forum’s recommendations on integration, education and training, public health and information and announced a number of moves in response.
However, there were no significant policy changes, instead the government response claimed many of the forum’s recommendations were already being enacted.
King’s Fund chief executive Chris Ham, who contributed to the Future Forum and has been the leading advocate of integration, told HSJ: “Our concern is these are warm words and good intentions but in practice they won’t be as much as we would like.
“There are not enough specific actions the government is committing to, which would give more confidence this was a real watershed.”
He said there was no “ambitious and specific measurable objective” for integration, which he has called for, nor any “guarantees” for patients, for example added to the NHS constitution.
Professor Ham also called for one of the health ministers to have a clearer role in leading integration.
He predicted there would be pressure on the DH to push integration further, including from Number 10. Professor Ham said the announcements were “the opening salvo from the department, but not the end of the war”.
One of the commitments the DH did make was to “encourage joined-up commissioning, and integrated provision” through its annual mandate to the NHS Commissioning Board. The DH will use the mandate to give the board its instructions.
The DH indicated some of the forum’s most significant recommendations were already dealt with. The forum recommended commissioners “should be allowed… to develop innovative local integrated solutions, including variations to tariffs and contracts”. The DH said that under the existing NHS operating framework 2012-13, variation is permitted where “the rules prevent [commissioners] doing the best for patients”.
On shared health and social care budgets – a key factor for proponents of integration – the forum recommended commissioners “must fully… explore the potential benefits” of joint commissioning and pooled budgets.
But the government only said it agreed commissioners “should explore the potential benefits of joint commissioning”, and pointed to the operating framework requirement for commissioners to ensure there is “a succession plan” for existing joint arrangements.
HSJ understands the government has no plans to mandate health and social care “mergers”, as has been reported.
The Future Forum integration report was led by GP Robert Varnam and former local authority chief executive Geoff Alltimes.