Chancellor George Osborne made an unprecedented move in February to devolve control for £6bn of NHS funding to local authorities and CCGs in Greater Manchester – as part of a strategy to integrate health and social care in the region.
And if the Tories get into power, this may not be the last area to see radical devolution of NHS funds on this scale (London is an obvious example). But there are mixed feelings about the bold move, with local GP leaders warning the plans could see the primary care budget ‘raided to support social care.’
The Manchester move rather eclipses the Government’s ‘Better Care Fund’ that sees £5.3bn of local government and NHS funds pooled to better integrate care, but it supports a move more generally away from competition towards co-operation.
Health secretary Jeremy Hunt said GP practices would be expected to work closely with job centres, social services and other community services in return for the £1bn funding promised to primary care in December and the thrust of NHS England’s Five Year Forward View is to see GPs working more closely with secondary care, community services and social care.
The Labour party has made the integration of health and social care one of the main focal points of its 10-year NHS plan, should it come to power after the election.
It’s big idea – subsequently watered down in the light of NHS England’s Five Year Forward View – was to radically expand the number of GPs being employed by hospitals in new integrated care organisations set up in every area of the country.
Shadow health secretary Andy Burnham has since said that it would also welcome GP practices becoming ICOs, rather than being employed by them, but his vision still involves providing incentives for ‘all providers’ to ‘evolve’ into ICOs. The ICOs will be set up in ‘every health economy’ and will be paid a single ‘Year of Care’ tariff to provide primary, secondary and social care to people deemed most at risk of hospitalisation.
The party has also promised to consult on how the ambulance service can be better integrated with NHS 111 and GP out-of-hours services.
Labour has previously revealed plans to strip CCGs of responsibility for commissioning services for ‘people with long-term conditions and hand it to health and wellbeing boards, but it is unclear whether this is still in the party’s plans if it wins the election.
Mr Miliband has also said that a Labour government would begin plans to immediately place a GP in all A&Es to stave off a potential crisis next winter.
The Liberal Democrats are also banging the drum for better integration of healthcare services.
The party has vowed to reform the current NHS payment system and introduce more local funding agreements – thus encouraging better integration of hospital and community care services and better preventative care for people with long-term conditions.
Party leader Nick Clegg has also said that he wants GPs practices to work together to provide care traditionally given in hospitals and practices to offer a wider range of services – to further alleviate the pressure on hospitals.
This would be funded by a £2.5bn healthcare fund pledged by the party.
In addition to this, the party has also claimed that it would potentially set up a new Department of Health and Social Care.
In the party’s manifesto it also pledges that it will keep rural GP surgeries open by co-locating with libraries or post offices and the sharing of budgets – as part of an ‘innovation fund’, although the value of this fund is not specified.
UKIP has also promised to integrate health and social care – claiming that it will ‘merge funding into one social care fund’, should it come to power after the election.
As part of this integration pledge, the party has also said that it will initiate pilots programmes to put GPs on duty in A&E departments seven days a week, to ‘ease the burden on A&E staff that need to treat more seriously ill patients.’
The party has said that it would encourage co-operation between primary care providers to promote the prevention of illness.
Scottish National Party
The SNP has pledged £300m over the next three years for the ‘Integrated Care Fund’ and £30m for telehealth. The investment will support integration, ‘meaning better local primary, community and care services’ in Scotland.
Pulse reality check
Some good ideas here, although the danger is that GP practices end up being swallowed up by hospital trusts amid the drive to consolidate care presented by the main parties.
NHS chief executive Simon Stevens is really setting the direction of policy in this area with his very well received Five Year Forward View and he is clear that he wants GP practices to be at the forefront of change in the NHS. But nine of the bids selected for additional funding to test Mr Stevens’ ideas were led by hospitals, and 14 led by GPs.
Practices have a real fight on their hands to ensure that the integration agenda does not lead to yet another power grab by trusts.