The NHS is currently making sense of the sweeping changes that took place on 1 April 2013.
Former Health Secretary Andrew Lansley’s NHS Act introduced greater fragmentation to the health service. NHS England, regional teams, commissioning support units, clinical commissioning groups, clinical senates, clinical networks and health and wellbeing boards need to decide when to compete and when to collaborate to treat ill health and improve public health.
The dust has not yet settled after April’s structural shake-up, and the NHS has a steep learning curve ahead. But the pendulum of political debate has already swung away from greater fragmentation of the NHS, and towards greater integration between the health and social care systems.
In the Comprehensive Spending Review, the Coalition government announced that by 2015/16 it will bring together £3.8 billion of the NHS and social care budgets to spend on services that are jointly commissioned by the local NHS and local council. Chancellor George Osbourne described this as: “Integrated health and social care: no longer a vague aspiration but concrete reality, transforming the way we look after people who need our care most.”
The Labour party is talking about going further. As part of Labour’s policy review, Shadow Health Secretary Andy Burnham is consulting on three options for better integrated care. The most radical is to: “fully integrate the health and social care services into a system of ‘whole person care’ – one budget, one service, coordinating all of one person’s needs; physical, mental and social.”
This work is supported by an independent Commission on Whole Person Care established by the Labour and led by Sir John Oldham.
Nothing matters more to people than their own and their family’s health and well-being. It explains why health and care are such central and emotive issues in our national life. People do not understand the difference between the health and social care systems, and they rightly resent the gaps that they or members of their family sometimes fall through. When we are ill, or growing older, we just want help and support when we need it.
All three main political parties are working on their manifestos for 2015. They will be keen to convince voters that they have the right policies to make integrated care a reality.
Measurement and evaluation