NHS and Integrated Healthcare Services
This House of Lords Library Briefing has been prepared in advance of the debate due to take place in the House of Lords on the motion moved by Lord Darzi of Denham (Labour) “that this House takes note of the creation of the National Health Service in 1948, and the case for integration of health, mental health, social and community care to equip the National Health Service for the next 70 years”. It provides a short history of the National Health Service (NHS), and summarises recent debates surrounding the integration of healthcare in England.
A five year plan published by NHS England in 2014 stated that there was a broad consensus in favour of removing the boundaries between different healthcare providers. Indeed, both governmental and non-governmental bodies have put forward the case for integrated care. The current Government reiterated its support in its recent announcement of real terms funding increases for the NHS, and the Labour Party has also stated that it is in favour of an integrated healthcare service. Reasons put forward include that it can lead to a more efficient use of resources and better outcomes for patients.
The five year plan set out how NHS England intended to achieve an integrated approach. This was primarily by creating organisations at the local level which would deliver a range of care services, potentially with delegated budgets. Reviews of progress since, including by the National Audit Office (NAO), have been mixed. The NAO concluded that there was no compelling evidence that integration provided financial savings or reduced hospital activity. However, NHS England has put forward examples of successful integration in some local areas. Meanwhile, developments continue in the various components of an integrated care system in England. For example, the Government has set out an intention to increase funding and staffing of mental healthcare, with a view to treating an extra one million patients a year by 2020/21, and achieving “parity of provision” with physical health services. On social care, a proposed green paper has been delayed, but is expected to be published this autumn. The Government has recently announced a funding increase for the NHS.