Vertical integration and the NHS Reforms: the missing link?

1. Vertical integration and the NHS Reforms: the missing link? Chris Ham University of Birmingham IPPR seminar

2. The Big Picture • 1900-50 Infectious diseases • 1950-2000 Acute diseases • 2000- Chronic diseases (LTCs) IPPR seminar

3. Service implications • Hospitals no longer at the centre of the health care system • Primary care becomes increasingly important • Care and services need to be integrated • People with chronic conditions are the main primary care providers IPPR seminar

4. Service integration • Vertical or virtual service integration are both possibilities • Continuity of care is often a priority for people with LTCs • Choice within or outside integrated care networks will also be important • Incentives need to support integrated care, and the policy aim of reducing hospital activity IPPR seminar

5. The policy challenge • Can the systems reforms support both competition and collaboration? • Will the incentives around elective care crowd out the changes needed in emergency care and long term conditions? • Is there a positive future for the acute hospital as a (smaller) part of an integrated system? IPPR seminar

6. SoS speech at LSE ‘In the new NHS there will be an element of competition…but we also want hospitals to collaborate – where appropriate, with each other, and with local GPs and PCTs…And although it may seem odd to expect organisations sometimes to compete and sometimes to collaborate with each other, it’s worth remembering that this is exactly what happens in the private sector’ 13 December 2005 IPPR seminar

7. The Integrated System – one possibility • Medical offices bringing together primary care, outpatient services, diagnostics and (in some cases) day surgery • Acute inpatient facilities providing intensive care and specialist services only for patients who require these facilities • Intermediate care in the form of reinvented community hospitals, nursing homes and integrated health and social care teams IPPR seminar

8. The promise of integration • Kaiser Permanente uses one third of the bed days as the NHS for leading causes of admission • The Veterans Health Administration reduced bed day use by 50% between 1995 and 2000 by transforming itself from a hospital system to an integrated system • Kaiser Permanente and the VA achieve good outcomes for patients IPPR seminar

9. Realising the promise • NHS Kaiser pilots in Birmingham, Northumbria and Torbay are giving priority to virtual service integration • Maintaining momentum and focus in the face of contradictory policy drivers requires committed leadership • Strengthening primary care and moving beyond ‘primary and secondary care’ is critical IPPR seminar

10. The questions • Where in the government’s plans are the incentives and levers to facilitate collaboration? • Is the planned care tail wagging the rest of the NHS dog? • Do Ministers understand that two thirds of bed days arise from emergency admissions where choice and PBR are less relevant? IPPR seminar