Integrated care

With the multiple challenges of tightening NHS finances, an ageing population and the growing burden of chronic illnesses, integrated care is seen by some as a key tool for improving the efficiency and effectiveness of care.

Many people (including people at Nuffield Trust) argue that integration can lead to both better outcomes and experiences for those who use services. In 2008 the Department of Health sought applications from sites that were interested in developing new models of clinically-led integrated care.

16 sites were eventually selected as pilots for the integrated...

Amongst all of the health reform activities in the United States, the formation of accountable care organisations (ACOs) is considered one of the more promising for bending the health care cost curve while improving patient outcomes.

ACOs are comprised of a group of providers who are held accountable for the cost and quality of care for a defined population of patients.

Successful ACOs are expected to manage costs by aligning incentives for hospitals,...

We’re all familiar with the challenges facing the NHS: the tightening budgets, the ageing population, the rising tide of chronic disease and how we organise services to provide a coordinated and seamless experience for complex patients.  What is perhaps comforting is that we are not alone.

At a recent conference, the Canadian Health Services Research Foundation (CHSRF) brought together 150 chief executives of various health providers from across the country to discuss these exact issues.  They were kind enough to...

High stakes with the Health and Social Care Bill last week. But at our Health Policy Summit 2012 we pushed aside for a minute big reform, structures, and long run consensus-dividers such as competition/choice, public/private, and command versus autonomy.

Instead, we majored on – as guest Don Berwick so thoughtfully put it – ‘contextually adaptive changes’.

A physician who was formerly chief of the Centers for Medicaid and Medicare and the Institute for Healthcare Improvement, Don was upbeat that with the right changes...

The Nuffield Trust’s fourth Health Policy Summit opens on Wednesday, bringing together senior health leaders, clinicians, policy-makers and academics. The timing is not auspicious.

The intense political wrangling over the Health and Social Care Bill has spilled out beyond Westminster and is dividing professionals in the NHS. Even at this late stage the Bill’s passage through Parliament is uncertain.

Whatever you might think of the Government’s proposals, the financial challenge that predated them is now a reality for the NHS. It is also rapidly becoming...

A centre-right coalition Government; an unsustainable hospital sector needing reform; an ageing population living with more chronic disease; calls for more integrated care; and a belief in the power of local clinical leadership to bring about such change. Sounds familiar? Well, up to a point.

Here in New Zealand, where Carol Black and I have been taking part in the Royal New Zealand College of General Practitioners' Quality Symposium, you have to pinch yourself, such is the commonality of much of the debate about our...

I got an encouraging letter from the Secretary of State responding to our and The King’s Fund’s analysis on how integrated care could be developed in England. Our publication and other bits are a synthesis of what we know, with some concrete suggestions on how to move ahead.

There is now a tailwind, and the Department of Health, NHS Commissioning Board and Monitor are currently mulling over how best to respond. More on this in the spring.

Meantime, for those weary of Kaiser and Torbay as examples, The Commonwealth Fund this...

What will 2012 hold for health care? Let’s ignore for now the inevitable political controversy and ideological teeth-grinding over health reform that will no doubt continue on both sides of the Atlantic.

If we focus instead on the payment and delivery system reforms that will preoccupy the health sector, then the concept of integrated care is likely to be somewhere near the top of the list (again).

Here, in the US, this means 2012 will be the year of the ACO – ‘the accountable care organisation’ – widely regarded as a cornerstone of the current reform agenda. The past...

This is a question that we knew we had to answer in a clear and convincing manner when the Nuffield Trust and The King's Fund were asked by the Department of Health to contribute to the development of its strategy on integrated care. 

Our report of this work: Integrated care for patients and populations: Improving outcomes by working together, has now been published.

We are all too aware of the fact that 'integrated care' and 'integration' can sound rather dry and hollow as concepts, leaving most people puzzled that care could ever be...

OK, so everyone is fed up with the Bill, just getting on with it, and focusing on having a break. But here are a few things from us to ponder at the end of this unusual year.

Ideological tussles will not go away next year. Alan Garber, now Provost at Harvard and our Rock Carling fellow this year, focuses his gimlet eye on one battle line: what place for competition, what dose, what unit of, and how could it encourage integrated care rather than get in the way.

Alan brings together his long experience of analysis in the US, and his...

Earlier this autumn, I had the opportunity to visit the Hospital2Home virtual ward project in New York. Like other virtual wards, this project aims to reduce the risk of unplanned hospital admission for people at high predicted risk of admission. 

I was particularly interested to visit this project because it has strong partnerships with health care, social care and charitable organisations, and it cares for some of the most vulnerable people in...

I’m only a couple of months into my year in the USA.

Breakfast with Lansley. Lunch with Berwick.  A chance meeting with Obama (Michelle, not Barack). And dinners with more top-rate health care academics, analysts and policy-makers from around the world than would have seemed possible just a few short weeks ago.

With this has come slides – lots of slides. Slides showing how bad things are here. Slides showing how good things are there. Slides showing how Japan is doing its best to make everyone look average, and slides showing how India plans to break the mould in eye-...

The joys of policy analysis mean the NHS Operating Framework is obligatory reading. 'Grip' is its message, no surprises there. But tucked in amongst the pages four things caught my eye.

Para 3.29 requires commissioners to link patient NHS numbers to contractual payments by March 2013. By then, it should be possible to identify routinely how much NHS expenditure goes on each individual – a crucial milestone to identify efficiencies. My bet is on information to give the NHS the biggest lift over the coming decade.

The second was para 4.24 – in response to...

‘Integration, integration, integration’ may not yet be on Channel 4 at 8pm on a Wednesday night but it is right up there on the agenda of the NHS.  It’s a central theme of the Health and Social Care Bill; it’s one of the key areas for the Future Forum’s second listening exercise; and perhaps, to quote Chris Ham, “it’s an idea whose time has come.”

Our involvement with the Nuffield Trust, participation in the listening exercise and in the newly convened ‘Integrated Care Discovery Community’ here in the northwest, has given us...

I recently had the opportunity to visit the Toronto virtual ward as part of my Management Fellowship role working with researchers at the Nuffield Trust who are evaluating the costs and benefits of the virtual wards in Croydon, Devon and Wandsworth.

The virtual wards work just like hospital wards, using the same staffing, systems and daily routines, except that the people being cared for stay in their own homes throughout.

The purpose of...

Integration remains a central theme in the Health and Social Care Bill, with work in progress around the country to try and make services less fragmented for patients and their carers.

At a recent workshop exploring how integrated care might be developed at pace and scale, which marked the launch of a new Nuffield Trust and King’s Fund project to support the development of a national strategy for the promotion of integrated care, participants agreed that financial pressures have created a ‘burning platform’, and that integration could improve patient...

The Future Forum has put integrated care at the heart of NHS reform. But who will ensure that integrated care is not crowded out by the emphasis on competition and any qualified provider, and what can clinical commissioning groups do to stimulate providers to work together to meet the needs of patients?

New research I have undertaken with Judith Smith and Elizabeth Eastmure draws on the experience of primary care trusts (PCTs) to suggest some answers to these questions. The research surveyed PCTs in England to understand how they were using their leverage as...

In the welcome breather from discussions over the Health and Social Care Bill, Nuffield Trusters have had a distinctly international flavour to our work. Professor Alan Garber, soon to be Provost at Harvard, gave our Rock Carling lecture examining how competition can coexist with developing integrated care. 

In the Q&A he gave some provocative responses: don’t rule out all forms of price competition for clinical care; and give GPs some direct (i.e. personal income) incentives for commissioning well.  For more details...

The Health and Social Care Bill is in better shape now. There are still some gaps (failure and designated services being the biggest) but best for the politicians to pass it and turn their focus to more pressing issues in the NHS – achieving more value for money. That is our main assessment as outlined in our initial response to the Bill Committee: Memorandum to the Public Bill Committee for the Health and Social Care Bill.

We are left thinking that the whole policy-making process has been less than desirable. Perhaps an overambitious reform...

I was in Glasgow earlier this month speaking at a British Geriatrics Society (Scotland) symposium about community services for older people.  Two things struck me: first, how refreshing it was to be at a conference where England’s Health and Social Care Bill was barely mentioned; and secondly the abundance of practical examples of health care integration from across Scotland.

One of the major criticisms of the Health and Social Care Bill was that its emphasis on promoting...