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MPs blame commissioning for lack of integration


12 February 2014

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Fragmented commissioning structures are making it harder to integrate health and care services, the health select committee has claimed. 
The committee’s annual inquiry into public expenditure on health and social care has recommended that health and wellbeing boards (HWBs) take over commissioning of joined-up health and care services. 

Fragmented commissioning structures are making it harder to integrate health and care services, the health select committee has claimed. 
The committee’s annual inquiry into public expenditure on health and social care has recommended that health and wellbeing boards (HWBs) take over commissioning of joined-up health and care services. 
Committee chair Stephen Dorrell said: “As health and wellbeing boards have been established to allow commissioners to look across a whole local health and care economy, their role should be developed to allow them to become effective commissioners of joined-up health and care services.
“Without stronger commissioners and ring-fenced health and care funding, we believe there is a serious risk to both the quality and availability of care services to vulnerable people in the years ahead.” 
The committee has called for “fundamental changes” if the health system is to meet the needs of patients. 
'Fragmented'
John Appleby, chief economist at healthcare thinktank The King’s Fund said: “A combination of unremitting financial and demographic pressures is having a significant impact on social care services – although  welcome, implementing the Dilnot reforms is only part of the solution. And while the establishment of the Better Care Fund provides an important opportunity to promote integrated care, it will not offset inadequate funding for social care and will increase financial pressures on hospitals.
“As the Committee points out, a more ambitious approach is needed to align health and social care resources around the needs of patients and service-users. This raises fundamental questions about whether to maintain the current separation between the NHS as a universal service, free at the point of use, and social care as a separately funded, means-tested service.”
Currently, the NHS budget is static, and the social care budget is falling, the committee noted. 
Dorrell noted that “successful integration” in these circumstances is a “growing challenge” but that the situation isn’t helped by fragmented commissioning structures. 
The committee has called for ring-fenced social care funding at the current level. This was suggested by the committee last year, but had not been implemented. 
Close to half (48%) of trusts are forecasting a deficit in the current financial year, the committee has noted. 
The senior group of MPs are calling for “transformative change” of the care model in order to meet the needs of patients. 
Dorrell said: “The fact that the number of NHS trusts and NHS foundation trusts reporting underlying deficits continues to grow represents evidence that the pace of change has not been sufficient to meet the challenge.” 

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