This document discusses next steps for integrating health services in England. It argues that simply combining existing public services does not create true integration, as these services have developed in silos focused on their own needs rather than patients. True integration requires new models of care delivery developed around patient needs. Competition from logistics organizations could help develop these new integrated models by organizing existing providers in new ways focused on collective outcomes rather than individual silos. This would disrupt the existing fragmented system and bring different approaches to integrating services.

1. Next steps in integration of health
services for NHS patients in England
Paul Corrigan
Monitor/Nuffield Conference
September 2011

2. Next steps in integration of health
services for NHS patients in England
• This years political overlay on the debate on
integration and implications for integration
• The single ownership of services on its own
fails to create integration
• What integration isn't
• The need for new models of delivery
• How competition could bring new models into
the field

3. This years political overlay on the debate on
integration and implications for integration
• Given the Government failed to develop a compelling
narrative for its reform, the need for integration
became reason number 176 to attack the reforms.
• The argument against bringing new providers of NHS
services into the market is that they fragment the
monopoly provider and therefore stop integration
• This assumes that existing monopoly public services
are already integrated and would be fragmented by
external intervention.
• The problem is the reverse. Existing public services are
deeply fragmented because they are a monopoly and
as such have not been challenged by new models

4. The single ownership of services on
its own fails to create integration
• The belief is that owning everything in one
organisation in some way creates integration
• The idea that a single state organisation creates
integration because it is a single organisation is
empirically wrong.
• For many decades state organisations have been trying
to integrate within single state monopoly providers let
alone between monopoly providers
• They have not succeeded between organisations nor
have they succeeded within an organisation
• Left to themselves the silo interests run the top of the
organisation NOT the other way round

5. What integration isn't?
• The culture in which each existing service has been
created has been one dominated by the needs of that
specific producer of that service
• Bringing existing health services provided by different
organisations together is NOT creating an integrated
service.
• Bringing all the other services together with health
services does not create an integrated service.
• For integrated services to work they need to be a new
form of service developed around the needs of the
patient and consumer and recognising the role the
plays in adding value to that service

6. The need for new models of delivery
• The existing business model for care has been created
by fragmentation.
• Integrated care needs a new business model and is a
disruptive innovation.
• What disruptive innovations are meant to do is …
disrupt
• Integration in other services happens because by
seeing logistics as a separate skill and overlay
• In other industries the logistics intervention provides
nothing but logistics.
• (Why should a specialist doctor be the person who is
good at the logistics of bringing all this together?)

7. How competition could bring new
models into the field
• Clear descriptions from commissioners and patient
organisations of the outcomes wanted from integrated
services that are based around patients and their ability to
add value with the patient .
• Encourage logistics organisations to enter into the field and
bid to organise existing individual providers and others into
new forms of services
• This will bring different methods for integrating the same
providers into different forms of what integration means.
• Incentives to ensure that the individual services provide a
new collective service and incentives against existing silo
work
• Learning for each form of logistic to create something new