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Commissioner tsar warns ‘more players on pitch’ poses integrated care challenge

Dame Barbara Hakin has warned the next two years will require the NHS to be ‘vigilant' to hold services together as commissioning becomes more fragmented.

She told a King's Fund conference in London yesterday: ‘We need to be particularly vigilant over the next year or two because the changes mean, to some extent, that there will be more commissioners on the pitch in certain areas and the risk that they don't hold everything together exists.'

Dame Barbara, the national managing director for commissioning development, added the NHS reforms were a ‘great opportunity' for integration to be improved but added that until now PCTs had commissioned the vast majority of care.

‘We are now going to have CCGs commissioning care and we're going to have the NHS board commissioning care and local authorities commissioning some public health services. ‘

She added more needed to be done to ensure patient experience is ‘not left to chance' and that commissioners should be asked to provide evidence to show patients experience of care had improved as a result of system changes.

‘This isn't necessarily just about clinical pathways, having a sense that the administrative system with which you are dealing can be just as important for patients as feeling your care is joined up.' she said.

Professor Chris Ham, chief executive of the King's Fund, said if the Government was serious about integrated care it needed a goal ‘not a target' centred on integrated care with the same status as 18-week waiting times or four hour A and E waits.

‘If we don't have a goal like that with sufficient political commitment and resource behind it then we'll probably in two, three years time still be talking about the small number of (integrated care examples). We need to learn from the last decade about how we've achieved progress.' Professor Ham said the goal to aim for should be centred on patient and user experience.  

National Voices chief executive Jeremy Taylor said while some of the performance management for such targets was ‘not particularly palatable' they held lessons on how to make systems change.

‘There was lots of pain, lots of resistance - but it kind of worked' he said.