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Will the government’s 14 integration pioneers be cut off at the pass?

1 November 2013

Steve Carefull and Lizzie Comley,social care experts at PA Consulting Group have responded to the announcement today by the Department of Health on the details of fourteen areas leading the way in delivering better joined up care.

By announcing details of the 14 pioneering areas that are striving to improve joined-up care, the government demonstrates its ambition to make integrated care a reality over the coming five years. With a commitment to ‘showcase innovative ways of creating change’, the pioneers are large-scale experiments in integration from which other areas should benefit. 

“However, the announcement comes as the whole system is grappling with unprecedented budget reductions. At the same time, the new spur of the £3.8bn Integration Transformation Fund means that pioneer areas – as well as every one of their neighbours – are required to make similar strides towards integration on a very challenging two-year timetable.

“Faced with this timescale, can the rest of the country afford to wait for the insight from the pioneers to come through?  

“There is the very real prospect that the pioneer areas will discover how to cultivate integrated care solutions, only to find that everyone else has already had to work out how to do it themselves. All areas, whether pioneers or not, need to be actively supported if they are to achieve the change necessary. Priority areas for help include: commissioning and contracting support and utilising payment flexibilities; assistance with governance arrangements for sharing patient data; and workforce development.

“There is neither a blueprint for health and care integration nor strong evidence for the impact it has, either on improving patient outcomes or in delivering efficiencies. The pioneer approach was therefore designed to encourage local creativity and establish what it takes to build sustainable integrated services.  

“With a package of support, but no extra funding from the government or NHS Improving Quality, the expectation is that the pioneers will become exemplars for delivering improved outcomes through integration. To be regarded as a success, they must:

  • tackle cultural and organisational barriers and realise savings for re-investment

  • achieve whole system transformation across a range of settings

  • test radical options, including new payment models

  • gather compelling evidence to build the value case.

“If they achieve these success factors, the pioneers will have much to teach others. The danger is that they will already have been ‘cut off at the pass’”.


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