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23 November 2010: The King's Fund Annual Conference

  • Last modified date:
    18 April 2011

Thank you Chris [Ham, CEO King’s Fund]. 

We are rightly proud of the Health Service in this country.  I was lucky enough to be in Washington last week, at the annual gathering of the Commonwealth Fund.  Every year, this august institution compares the healthcare systems of developed nations around the world.  And in many ways, the UK came out very well.

In terms of access, equity and cost, the NHS generally performs better than others.  If you get sick in the UK, you don’t face the fear of being unable to pay potentially vast medical bills as you might elsewhere.  You can see a doctor reasonably quickly.  And if you get seriously ill, people in Britain are confident that they will get the care they need.

So should we just sit back and congratulate ourselves on a job well done?  I don’t think that would be wise.

While we do well when it comes to equity, we do not combine that with consistent levels of excellence.   

• In Britain, you are twice as likely to die from a heart attack than our cousins are across the Channel in France.

• Survival rates for cervical, colorectal and breast cancer are amongst the worst in the OECD. And,

• When it comes to premature death from respiratory disease, we compare poorly to the leading European countries.

And think of the poor individual who gets sick, particularly if they need both hospital treatment and social care.  There may only be one person in need of help, but the organisations they need to deal with are multiple.  Each with their own forms to fill, staff to meet, assessments to make, plans to draft and procedures to follow.  And you’re having to deal with all of this while you’re ill.  When all you want is to be is to be left alone and let others take care of everything for you. 

And think of the taxpayer.  We all know the financial context is challenging and that we need to be as efficient as possible with the resources at our disposal, so is this really the best way of doing things?

I hope that, by being here today, and having spent the whole day discussing integrated working, you will agree that it is not.

Think for a moment of the benefits of truly joined up services.  Where GPs and other healthcare professionals, social care providers and the various parts of the local council all come together to provide seamless services.  Where, as far as the patient is concerned, the lines drawn between these organisations fade to nothing. 

Proper integrated working will produce better outcomes for patients and a far better return for the taxpayer. 

We all know this.  To give them their due, the previous government knew this too.  It’s all very well to talk about integrating services, we’ve been doing so for years, but it doesn’t happen by talking about it.  Organisational culture, professional boundaries and everyone’s personal and professional boxes – so hard to break out of – all act to block the path of progress.

Patient Power

So what can we do to break this model and really get things moving?  I think we can do it in a number of ways, but essentially we need to push power to – or as near as possible to – the one person who is common throughout – the patient and the service user.

Our White Paper, Equity and Excellence: Liberating the NHS, puts the patient in the driving seat and places everything else in the NHS and beyond in a position to support this fundamental shift in gravity.

There are really two aspects to patient power – giving them control over their own care and giving them the information and the tools to exercise that control.

Patients will be able to choose their GP and, with their doctor, their hospital or NHS provider, their consultant team, even their treatment where this is appropriate.  And because the money will follow the patient, their choice really matters. 

But you cannot choose unless you have options to choose from.  This is one of the main reasons for opening out the delivery of NHS services to any willing provider.  The other being the power of competition to drive up quality whilst at the same time lowering prices.

And because it is impossible to make an informed choice between providers unless you know what it is you’re getting, we will start an information revolution. 

We will make unprecedented amounts of data available for all to see – patients and their representatives, professionals and the public – in a clear and easily comparable way. 

But in a way, even this is a job half done.  A real impetus for change will come as we hand financial control to the patient.  Last week, we published our vision for social care.  A central pillar of which is the roll out of personal budgets and making it possible to combine social care budgets with personal health budgets.

Think of Jane.  She has Huntington’s and is cared for at home by her husband.  He uses her personal social care budget to employ a Personal Assistant during the day to support his wife. 

When Jane’s condition deteriorates and she needs 24-hour NHS care, thanks to the Personal Health Budget pilot programme, was able to employ the same Personal Assistant and also pay for additional over-night care.  Continuity of care is ensured and as no agency fees are paid, saving money.

Personal budgets will give people real control over the way their money – and it is their money – is spent, giving them real choice.

The pilots will continue to run until 2012 and I very much encourage you to join in. 

But before then, by designing services around the individual, we want system to break free of cosy organisational silos and unite. 

Patients need health and social care, councils and their partners to come together, integrating services not around systems and processes, but around individuals and outcomes. 

And it will be those organisations that do this, that improve outcomes the most, that make the patient’s or service-user’s experience as simple as possible and that operate most efficiently, that will prosper. 

GPs

Throughout, patients will have the support of their GP.  A GP who will be an integral part not only of their personal care but of designing local health services based on the latest evidence of what works and with clear responsibility for the costs of those services.

But this is not a case of the GPs getting together to decide unilaterally what services should look like.  In fact, the opposite is true.

GPs are perfectly positioned to coordinate services for their patient.  Why?  There are 300 million reasons.  That’s 300 million appointments every year, seeing every conceivable type of patient with every conceivable ailment. 

GPs take a broad view of care, working with others across primary, community and secondary care to manage, treat and refer their patient. 

They are ideally positioned to take precisely the same approach when designing services in collaboration with all appropriate people within and, importantly, beyond the NHS, including with patients themselves.  All coming together to design flexible, integrated services built around the needs of the individual.

Already, early adopting GP Consortia Pathfinders are coming together to take increasing levels of responsibility from Primary Care Trusts.  From the outset, they are working in partnership with their colleagues in social care and local councils.  These relationships are not a nice add on – good practice, but not essential to the real business of healthcare.  They are the core of good GP-led commissioning. 

And we already have the experiences of the Integrated Care Pilots to draw on.  These demonstrate the incredible levels of innovation that are possible when people are brought together and encouraged to solve problems as a team for the benefit of an individual. 

For example, in Wakefield, a pilot on substance misuse has developed close relationships with Job Centre Plus and the criminal justice system, allowing a far more holistic approach to the service user.

And whether in a Pathfinder, a Pilot or not, clinicians everywhere will need to start working with their local councils as they start to develop Consortia.

And Primary Care Trusts will need to work with local authorities to develop their QIPP and reform plans.

We said in the White Paper that councils will play a strategic role, promoting the integration of health and adult social care, children's services and the wider local authority agenda, bringing a whole new level of democratic accountability to local services.

The consultation asks how we can best do this – possibly councils and GP consortia working together in Health and Wellbeing Boards in local authorities.  We’re still looking at this, although we hope to publish our response shortly.

And while they will be phased out, Primary Care Trusts have a vital role to play in the transition to the new system.  I ask all PCTs to start working now with GPs and councils, if they are not already:

• to support local authorities to adopt their new, strengthened strategic role in relation to health and social care,
• to put in place solid succession plans,
• to ensure that knowledge is shared, and
• to transfer existing pooled budgets and joint commissioning arrangements.

Another thing that will spur greater integrated working is shared funding.  When this government was elected to office, we knew that, with the steps we need to take to reduce the deficit, local government funding for social care would come under pressure.

With rising demand for social care services from an aging population, we knew that we would have to act to prevent a deterioration in services and an increase in emergency admissions to the NHS.

This is why the NHS will set aside funding, rising to £1bn in 2014-15, to support social care.

This will fund social care services that specifically benefit health, and improve health outcomes for individuals.  Things like re-ablement services, which can help people regain their confidence and independence following discharge from hospital.  We’re doing this because we understand that the NHS does not stand alone.  The NHS is simply one part of a larger care system in this country. 

And there will also be an additional £1bn by 2014/15 going through local government to support social care services.

This means, as long as we get the efficiency savings we know are possible, there will be enough funding available both to protect people’s access to services and deliver new approaches to improve quality and outcomes.

Today the King’s Fund have published their report on integrated care.  I welcome this report.  Particularly because it agrees that, "There is no inherent contradiction between choice and competition, on the one hand, and integration on the other; both should be encouraged."

This is exactly right.  To give a practical example, GP consortia could design and negotiate long-term contracts, integrating the range of services needed for a population with multiple, complex needs – such as for those approaching the end of life.  Or the care and support of frail older people. 

They can then contract with one or more lead providers, placing the responsibility for co-ordinating the different services and resources required  where it belongs – with the provider.  Such contracts can give individuals choice either between the main contract providers, or more likely, through their sub-contractors – providing choice of different treatments settings and staff.  The East of England is currently developing a model based on these lines.

And on the provider side, new, innovative social enterprises will be well-placed to integrate services.  Forging new partnerships with NHS providers, local authorities and voluntary organisations.  The Right to Request Social Partnership in Hull, City Health Care Partnership, is already actively building these new relationships across health and social care and far beyond.

Conclusion

While the financial context is challenging, this is an exciting time for the NHS.  We have an opportunity to reverse the decades long trend of centralising power.  Bringing new life to communities, professionals and individuals by empowering them to act in their own best interests.

As I said at the beginning, the NHS has an admiral record when it comes to equity and access.  But that alone is not enough.  Our goal is to achieve health outcomes that are among the best in the world.  To have equity and excellence.  And the only way we will achieve this is by placing our trust in patients, service users and those who actually deliver the care we so want to improve.  Not just in the NHS, but across all those who provide care and support for the individual.

Integrated working, centred around not only the needs, but the wants and the preferences of the individual patient, will go a very long way to achieving this goal.

Thank you.

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