Professor Ross Millar on the future of integrated care
The feasibility of proposed shifts in care - hospital to community, analogue to digital, sickness to prevention – that are envisaged by the NHS 10-year plan remain open to debate, with many contributions raising issues and challenges to the various proposals being introduced.
A key fault line for implementation is how the plan envisages integrating care: that is the joining up of health and care services required by individuals, to deliver care that meets personal needs in an efficient way. Key highlights include:
Existing evidence shows the possibilities and challenges that await. Vertical integration can promote collaborative working, generate reductions in A&E attendances, and improve co-ordination. However contractual issues require consideration as well as the digital, cultural and trust-building investment for any integration to occur. Public-private-partnerships can generate much needed capacity, as well as clinical and service innovation, yet their long-term value for money remains a contentious issue. The digital integration of patient data clearly holds promise, but it has a long and chequered history and where the usefulness of AI is clear; infrastructure, education and regulatory frameworks would need to follow. NHS App usage has substantially increased post-pandemic but roll out and the digital inverse care law are likely to await any further innovation.
While the plan’s shift to science and technology integration is clear, there are notable gaps elsewhere. How the plan will realise the ‘cross-societal energy on prevention’ involving local government, civil society and third sector organisations remains unclear. Furthermore, many of the system conditions needed for integration to flourish remains in a state of flux and arguably in demise. The withdrawal of NHS England and significantly reduced budgets for Integrated Care Boards as ‘strategic commissioners’ leave system wide (horizontal) relationships and networks for integrated care to be achieved highly exposed.
Policy analysts describe how if policy does not consider the external environment, then policy drift can occur: as the external environment shifts, a policy can lead to unintended consequences or a divergence from its intended and actual effects. Evidently for any vision of integrated care to be realised, and for the NHS to become ‘the world’s most collaborative public healthcare provider’ as declared in the plan, will require cross-sectoral and cross-government policy solutions to address the health challenges the nation is facing. How the plan integrates with a health agenda that includes social care, work and employment, education, housing, and climate change adaptation will ultimately shape its desired outcomes. And how the plan builds trust and faith in its proposals with a resource depleted workforce and connects with the place where patients and communities engage with the NHS will ultimately shape its destiny.
The withdrawal of NHS England and significantly reduced budgets for Integrated Care Boards as ‘strategic commissioners’ leave system wide (horizontal) relationships and networks for integrated care to be achieved highly exposed.
Director of the Health Services Management Centre (HSMC)
At HSMC Professor Ross Millar he has been involved in a variety of policy evaluations that include examining the impact of market based reform, the promotion of social enterprise in health and social care.
