The future organisation and delivery of care

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There are longstanding fault lines in the provision of care that result from historic divisions between budgets (that is, between major groups of health providers and between health and local authority funders of social care), institutions and professions. Commissioners of NHS-funded care, such as primary care trusts and practice-based commissioners, have not been able to overcome these problems, despite various opportunities open to them.

As the pressure increases to improve efficiency and enhance quality, NHS managers and clinicians are starting to look at new ways of organising and delivering care.

The concept of integrated care, and integrated care organisations (ICOs), has been emphasised as a means to achieve better care for patients. The premise of integrated care is that it will not only help to improve the coordination of care for patients and therefore prevent avoidable ill health, but also that it will result in greater value for money.

While the formal evidence underpinning this premise is as yet underdeveloped, the wide variations in avoidable use of hospital care, in particular, suggest the scope for large gains in efficiency and health.

In the video above, our Director, Dr Jennifer Dixon examines the latest developments in integrating services between primary, secondary, community and in some cases social care as a way of helping the NHS respond to the financial challenges ahead.

Related reports and events

A major part of our work programme is examining the potential of new forms of care that are intended to benefit patients and taxpayers. Key projects include:

• High-performers: we are analysing a number of high-performing care organisations in the UK and internationally to see how they improve the coordination of care for patients with complex needs. A report will be published in autumn 2010.

• Barriers to integration: in summer 2010, we will publish a report that examines the policy opportunities and barriers faced by five NHS sites that are at the forefront of developing new forms of integrated care. This follows a series of seminars we held in late 2009 and early 2010 involving presentations from senior managers and clinical leaders from Nottingham, Torbay, Trafford, Whipps Cross, Redbridge and Cumbria. Click here for further information and to download write-ups from each of the five seminars.

  In addition, we will conduct an in-depth analysis of an NHS organisation that is trying radically to develop an ‘office medicine’ approach to the local organisation of care.

• Incentives: Professor Alan Garber, Stanford University, California, who was awarded our Rock Carling Fellowship for 2009, will publish the findings from his analysis of incentives in the NHS that are helping or hindering the development of integrated care. A report will be published in autumn 2010.