A fragmented system can't deliver whole person care

The conclusion of Sir John Oldham’s independent commission on whole person care cannot be clearer: the fragmentation of care, driven by deep professional and organisational boundaries and supported by perverse payment mechanisms, cannot continue if the NHS is to remain faithful to its founding principles.

Sir John’s report outlines a series of recommendations that could deliver a system of care with the individual at the centre, one that is not only higher quality but also more sustainable. Its key themes fit with the ideas mapped out in our NHS@75 work.

‘At the heart of this vision is a new relationship between commissioners and providers based on the outcomes that matter to people and populations’

A central part of this approach is “making the money work” around the needs of individuals, requiring a change in the way care is commissioned. The report recommends that local health and care budgets should be treated as whole, and a payment system developed which treats people’s needs together rather than separating them.

This type of capitated payment system, covering all of a person’s care for defined population groups, requires local providers of care to work together to deliver coordinated services across different care settings. A person’s budget can be used for a single aim: care. It also means that resources can be shifted to where they will deliver most value.

Link payments to outcomes

Commissioners must link payments to the outcomes that matter to the people using the services. For older people, for example, a key outcome is likely to be maintaining independence. While commissioning for outcomes sounds simple, the experience of early innovators shows us that it isn’t. It means a very new way of working for commissioners, and a real change in the way people using the system are involved in shaping their care.

Commissioning is only one element. It will be providers who make this shift a reality. Hospitals will have to innovate and adapt to change the way they operate and become much more than a set of buildings and people responding to crises. Extended models of primary care must also increase the scope and range of their activity.

‘Hospitals will have to innovate and adapt to change the way they operate and become much more than a set of buildings and people responding to crises’

At the heart of this vision is a new relationship between commissioners and providers based on the outcomes that matter to people and populations.

Over the next year we need to see many more local care economies collectively working to move towards a more integrated approach. Some already are – we’re working with a number of health and social care economies that are making the first bold steps required. Yet making this type of care the norm will require a transformational step change in health and social care delivery, and urgently.

Without this change, our increasingly fragmented health and care system will be unable to meet out changing population needs. 

Dr Tim Wilson is a partner and Janet Dawson is healthcare lead partner at PwC