1 September 2010
Health policy experts have called for the government to
encourage joint working in the NHS, criticising the ‘perverse incentives’ and
existing barriers to collaboration in the system.
A report, Removing the policy barriers to integrated care in England, was published today by the Nuffield Trust and co-authored by Chris Ham, chief executive of the King'sFund. It argues that making the NHS more integrated could raise standards of living and make the service more efficient.
But it criticises several current policies for working against joined-up care.
The report singles out the foundation trust project and the regulatory regime run by Monitor, which requires hospital managers to generate budget surpluses each year, to be set aside for future investment.
The authors argue this system encourages managers to think
of each trust as a separate entity, and to increase the amount of NHS work done
in their hospitals, despite it being in the interests of patients and the
public finances to reduce avoidable admissions. Similarly, Payment by Results
creates perverse incentives, the report says. Meanwhile, emphasis on
competition between acute care providers could hamper the emergence of new NHS
bodies, which would provide a more integrated service.
Ham and co-author Dr Judith Smith, head of policy at the Nuffield Trust, argue that GP commissioners must closely involve secondary care doctors in commissioning.
The report concludes that July’s health white paper, which proposes to put commissioning budgets in the hands of GPs while increasing competition between acute care providers, can still make the NHS more joined-up.
But the government must also recognise the importance of collaboration in designing care packages for patients with complex needs, over the need for more competition, the authors add.
