Integrated care’s giant leap forward

Selecting the chosen 14 integrated care pioneers was a difficult task. There was much impassioned debate among the selection panel members as to which of the 28 high quality shortlisted proposals would become pioneers. But, eventually, a final list was agreed. All of the successful applicants demonstrated an ambitious and innovative approach to how they will deliver person-centred care and support.

‘The pioneers offer us the opportunity of finding out what practical steps could make person-centred, coordinated care a reality on a much bigger scale’

Integrated care is not a new concept and, in pockets of the country, there are excellent examples already in place. However, the pioneers offer us the opportunity of finding out what practical steps could make person-centred, coordinated care a reality on a much bigger scale. Additionally, they will provide an excellent mechanism to rapidly share good practice and knowledge across the health and social care sectors. Given that the objective is to bring about this transformation by 2018, we will all have to learn fast from the pioneer localities’ hands-on experiences.

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What needs to change

My role at Monitor involves me not just working on integrated care but also redesigning the NHS payment system. Together, these elements give me a clear understanding of the obstacles that frustrated a good number of the past attempts at integrated care, and an idea of what needs to change.

For example, payment by results is often cited as a barrier to driving forward more integrated care. Originally designed to increase acute productivity, it does not promote prevention and person-centred care. In response, we propose (in the new national tariff) to allow local variations that will bring a new flexibility to the payment system from April 2014. Pioneers, such as the successful bid from North West London that is putting GPs and community practitioners at the heart of a coordinated local health system, may find this particularly useful.

We are also working hard to debunk myths around our regulatory approach, notably that choice and competition are incompatible with integration. We believe that most services aimed at providing good integrated care would not raise any competition concerns.

Our intention is to help pioneers create and deliver integrated services that increase service user involvement. People should not just be passive recipients of care; they and their families should play an active role in shaping their care pathways. For example, the Islington pioneer locality has proposed to create tailored care plans for people to help them take control of their own health and wellbeing.

Finally, integrating care systems could also open up new sustainable solutions for many struggling local economies. The Greenwich pioneer proposal (caught up in the dissolution of the South London Healthcare Trust) tackled this head-on in its successful bid which focuses on prevention, early identification and care coordination.

During the past year, Monitor has also begun to tackle many of the other problems that exist to delivering integrated care. The licence that Monitor issues to the health services providers that it regulates requires organisations not do anything that would get in the way of more integrated care. And many of the regulatory levers that we now have at our disposal, largely around pricing and competition, can help push it forward. Put simply, we want to stop anyone consigning integrated care to a box marked “too difficult”.

Two-way process

But Monitor, of course, is not a frontline service provider. We intend to offer the pioneers support but do not want to be prescriptive. Our dealings with the pioneers will be a two-way process. What they tell us and the lessons they learn on the frontline will help shape what we do in future.

Making integrated care the norm within a few years is now imperative for the NHS and local government as they struggle with tough resource constraints. Monitor’s report Closing the NHS funding gap: how to get better value health care, published in October, estimated that the annual gap between resources and demand will be £30bn in less than a decade. The evidence suggests that reconfiguring services and integrating care effectively across providers could yield productivity improvements in the region of £2.4bn to £4bn by 2021. That would be an important step towards making quality care sustainable.

‘Evidence suggests that reconfiguring services and integrating care effectively across providers could yield productivity improvements in the region of £2.4bn to £4bn by 2021’

At its heart, integrated care is about improving overall quality and, not least, the patient experience. Straightforward measures such as seamlessly sharing service users’ records among the appropriate caring organisations could save much indignity and frustration. Integrated care is an idea whose time has come and we are determined to help everyone – and not just the pioneers – make it a reality.

Catherine Pollard, Monitor’s head of pricing and integrated care, sat on the final selection panel for the integrated care pioneers programme.