The NHS is more fragmented than ever

Are ministers prepared to provide the means required to deliver integrated care?

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The Coalition Government’s NHS reforms have resulted in a degree of complexity never seen before. The reforms have also extended the use of competition by requiring many services to be put out to tender and giving the OFT a role in reviewing proposed mergers between NHS providers.

Both the organisation of care and how it is provided have become more fragmented as result. Is it therefore credible for Jeremy Hunt and Norman Lamb to argue that care needs to be integrated to meet the needs of older people and others with complex needs?

The answer depends on whether Ministers are prepared to provide the means that are required to deliver integrated care. A welcome start has been made with the decision to grant 14 areas of England the status of pioneer communities with support to take forward integrated care at scale and pace.

Equally important is the transfer of almost £4 billion from the NHS ring fenced budget into the Better Care Fund. This will be available to all areas of England to pump prime services that bring together health and social care.

Ministers must also be willing to review the role of the OFT in mergers, ensure the Care Quality Commission assesses how organisations work together, and insist that the right incentives are in place to develop integrated care. They must make it clear that competition should be used selectively rather than as an organising principle.

Failure to do so will make the government vulnerable to the charge that it is intent on undermining an institution that remains dear to the hearts of the British people.

Prof Chris Ham is chief executive of The King’s Fund

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