Integration versus integration

Guest blog by David Boot, Editor, Healthcare and Life Sciences, Novares

At the end of July the Care Bill sluggishly completed its Committee Stage in the House of Lords, making it an ideal time to reflect on the social care debate. Come the party conference season in September, this debate will no doubt be one of the key themes the three main parties will be grappling with. Chief issue up for debate will be ‘integration’.

For Care Services Minister Norman Lamb 10 integration ‘pioneers’ will show the rest of the NHS the way, with support from a central Integrated Care and Support Exchange team helping to support ambitious local experiments. For opposition voices, a more coordinated integration response is called for, with both the Shadow Secretary of State for Health Andy Burnham and the Conservative Chair of the Health Select Committee advocating this.

But how do these two alternative views of integration differ?

Helpfully the Social Market Foundation pitted Burnham and Dorrell against each other in a head-to-head event in July in order to highlight their differing opinions. Both have spoken widely on the need for greater integration, but the positions of Burnham and Dorrell are distinct in three broad ways.

Firstly, the breadth of integration. For Labour, only full integration of health and social care, focusing on whole person care, will do. Burnham is clear that the current system drags funding towards the acute sector, which, he argues, can only be remedied through full integration. If there was a financial incentive to keep people at home rather than in hospital – a year of care approach – then this would tilt funding towards social care. For Dorrell, moves to a single budget to commission health and care would allow for flexibility in the way care is delivered, something necessary in a mixed system of free at the point of use and means-tested care.

Secondly, whether there should be a national or local approach to integration. For Burnham, a national system is essential in giving patients certainty around what to expect whilst allowing governments to plan services more strategically. Again Dorrell adopts a more flexible approach, calling for a balance between the national and the local, with governments being honest about the issue of local variations in care. For Dorrell a local approach allows for innovation, helping to drive improvements through the NHS.

Thirdly, whether there is a choice between integration and competition, and whether one undermines the other. For Burnham, here there is a clear choice between integration and an any qualified provider model. He cites Torbay, a beacon of integration, as an example of the problem of competition undermining integration, with the Office for Fair Trading looking to take action over the bringing together of local services. For Dorrell, commissioning is key. He argues that a single commissioning budget would get away from a fragmented service as integrated pathways could be commissioned. For the chair of the select committee, there is nothing stopping commissioners from commissioning integrated services, and competition merely allows for different integrated models to vie for contracts.

For the Government, integration will happen from the bottom-up, for Stephen Dorrell successful commissioning is key, and for Labour only a full merger of health and social care can work. The simple truth is that everyone is in favour of integration; it just leaves the question how to achieve this and whether anyone can stomach another NHS reorganisation. Whatever happens over the coming months, expect integration to be on everyone’s lips for quite a while yet.

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