One of the main consequences of last yearâ€™s pause in the passage of the Health and Social Care Bill was a blizzard of amendments to the statutory duties of every single NHS organisation. Amongst the many contradictions that arose from these amendments, there was one constant. By the time it became an Act, after the Bill was amended and re-amended in the Lords every single possible organisation had had a duty to create integrated care laid upon it.
Last weekâ€™s mandate for the NCB from the Secretary of State has begun to put some flesh on the bones of how it will be expected to carry this out,
2.1 We want to empower and support the increasing number of people living with long term conditions. One in three people are living with at least one chronic disease. By 2018 nearly 3 million people, mainly older people, will have three or more conditions all at once
2.7 As a leader of the health system, the NHS Commissioning Board is uniquely placed to co ordinate a major drive for better integration of care across different services, to enable local implementation at scale and with pave from April 2013
2.8 The focus should be on what we are achieving for individuals rather than for organisations- in other words care that feels more joined up to the users of services with the aim of maintaining their health and well being and preventing their condition deteriorating as far as possible. We want to see improvements in the way that care
- Is coordinated around the needs, conveniences and choices of patients, their carers and families- rather than the interests of the organisations that provide care
- Centres on the person as a whole rather than on specific conditions
- Ensure people experience smooth transitions between care settings and organisations including between primary and secondary care, mental and physical health services, childrenâ€™s and adult services and healthy and social care- thereby to reduce health inequalities
- Empowers service users so that they are better equipped to manage their own care as far as they want and are able to.
The NCB will quite rightly pass many of the main ways to implement this mandate onto CCGs. I will explore in a later post what that might mean.
But the NCB is not only a performance manager of CCGs it is also commissions health care itself.
The NCB commissions Â£12 billion of specialist health care. If it takes the Secretary of Stateâ€™s mandate seriously we would expect to see this enormous buying power used to ensure that the services that it buys bought from specialised providers would be part of an integrated care pathway.
This will not be easy (but NOTHING about creating integrated care in the NHS will be easy) because most specialist commissioning is a specific episode of care. However specialist episodes of care, like all other care, need to be part of a pathway of care. The NCB will have to put these episodes alongside the care before, and especially after, the specialist episode to turn it into a pathway. This will be difficult because care on both sides of specialist episodes will be commissioned by local commissioners (CCG and local authority).
But if the NCB wants to demonstrate how it is carrying out its mandate it will have to make this happen.
However there is a much more direct impact that the NCB has through the Â£20+ billion of GP services that they buy. (One of the odder aspects of this localising reform was the nationalisation of the commissioning of GP services that has taken place.)
GPs will be key to integrated care. Indeed it is very difficult to understand how there can be an integrated care pathway without them.
So if the NCB is going to carry out its statutory duty to develop integrated care, and if it is going to play its role in developing that part of the mandate on integrated care, it will need to radically develop the GP contract. That contract, like every other part of the NHS needs to contain incentives to develop integrated, not just episodic, care. Read the rest of this entry »