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<strong>Board</strong> of Directors10 June 2011THE ROYAL BOURNEMOUTH & CHRISTCHURCH HOSPITALSNHS FOUNDATION TRUSTWhere next for the NHS Reforms?The Case for Integrated CareThe attached paper authored by the Kings Fund is provided to the <strong>Board</strong> of Directorsfor information. It provides a thoughtful and thorough assessment of theopportunities The Pause presents for reviewing aspects of the Health Bill. Inparticular, it sets out the case for a more searching diagnosis of the problems/challenges facing the NHS and sets out a new model of integrated care in whichclinicians work together more closely to meet the needs of patients and co-ordinateservices. The model of integrated care focuses more on preventing ill health,supporting self care, embracing primary care, and increasing co-ordination betweenprimary care teams and specialists and between health and social care.There are a number of facets of this approach which would serve Dorset well inresponding to the challenges that lie ahead.This paper is provided for information.Tony SpotswoodChief ExecutiveWhere next for Health Reforms? Page 1 of 1For Information
Where next for the NHS reforms?The case for integrated careAuthors:Chris HamCandace ImisonNick GoodwinAnna DixonPatrick SouthThe King’s Fund11–13 Cavendish SquareLondon W1G OANTel 020 7307 2400Registered charity: 1126980www.kingsfund.org.ukSummaryThis paper sets out the challenges facing the English NHS now and in the futureand identifies the reforms we believe are needed to meet these challenges. It hasbeen written as a contribution to the listening exercise initiated by the coalitiongovernment following the announcement at the beginning of April of a pausein the parliamentary passage of the Health and Social Care Bill. It builds on TheKing’s Fund’s response to the health White Paper published in July 2010 (Dixon andHam 2010), our briefing for the second reading debate on the Bill in the House ofCommons (The King’s Fund 2011a), and our extensive programme of policy analysisand research.The main argument of the paper is that reforms to the NHS must be clearly focusedon, and proportionate to, the challenges it faces. One of the reasons the coalitiongovernment has run into difficulty is that it moved very rapidly to set out radicalchanges to the NHS without having first clarified the problems that these reformswere meant to address. The King’s Fund is in no doubt that in some areas there isscope to improve performance and to move closer to the standards of care achievedin other countries, but we suggest that a clear diagnosis of the state of the NHStoday is needed to inform the design of future reforms.The NHS is faced with the major challenges of using resources more efficiently andof meeting the needs of an ageing population in which chronic medical conditionsare increasingly prevalent. The key task therefore is to implement a new model ofcare in which clinicians work together more closely to meet the needs of patientsand to co-ordinate services. This model of integrated care would focus much moreon preventing ill health, supporting self-care, enhancing primary care, providingcare in people’s homes and the community, and increasing co-ordination betweenprimary care teams and specialists and between health and social care.There are many barriers to the implementation of integrated care, includingorganisational complexity, divisions between GPs and specialists, perversefinancial incentives, and the absence of a single electronic medical record availablethroughout the NHS. The coalition government’s proposed reforms have thepotential to help overcome some of these barriers but they could also make it moredifficult to achieve closer integration of care unless they are modified in a numberof areas. Our paper Liberating the NHS: The right prescription in a cold climate?proposed a series of modifications centred on the argument that well-designedreforms must strike a balance between collaboration in some areas of care andcompetition in others (Dixon and Ham 2010).In this paper, we offer suggestions for revisions to the current Bill and future policydevelopment but we also lay out a more radical model that we believe holds theprospect of greater progress towards the vision of integrated care and a healthsystem sustainable in the longer term.© The King’s Fund 2011
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