At last - some disagreement about integrated care

“We have shot the opposition’s fox.” That was the line fed to HSJ as Jeremy Hunt announced the decision to triple the size of the pot made available to joint commissioners of health and social care.

‘Behind the politicking there are some important policy strands emerging’

The £3.8bn would fund key integration initiatives, spark a cultural change in cross boundary working and lead to seamless services for many − all without the disruption of Labour’s proposed wholesale transfer of the NHS budget to local authority control.

Mr Hunt’s excitement was obvious as he declared this was “a game changer that no one was expecting”.

Different models

But behind the politicking there are some important policy strands emerging. Last month, Labour’s Andy Burnham said there would be no “big bang” reform and “local areas” would be able “to decide how quickly they would move towards this vision”. It sounds like he had been expecting Mr Hunt’s riposte.

In his HSJ interview, the health secretary stressed how the joint commissioning would improve the clinical care of the vulnerable elderly - to such an extent his advisers rang journalists explaining how the new fund would have wider applications.

‘It is much better to realise there are many ways to define and deliver integrated care than to pretend we all agree’

Mr Hunt was combating accusations the commissioning fund would reduce NHS spending and he has made no secret of prioritising improvements in elderly care. His Lib Dem junior Norman Lamb, on the other hand, appears to see integration primarily as a way to cope with fragmentation in care services. The scrutiny the integration pilots will receive look likely to spark much internal debate at Richmond House.

This is good news. It is much better to realise there are many ways to define and deliver integrated care − and to examine the difficulties and opportunities they represent − than to pretend it is some kind of panacea on which all will agree.