David Cameron has ordered health and social care services to be brought together in order to benefit patients in a move which government advisers are calling the NHS's most urgent overhaul. At the moment, health and social care – the help given mainly to old or disabled patients to help them continue to live at home rather than in hospital or nursing homes – are different systems in England. Cameron made integration one of his five "personal NHS guarantees" last year.
NHS medical treatment and domiciliary support, which is provided mainly by local councils, are usually not joined-up. However, Cameron has told the health secretary, Andrew Lansley, to drive through changes that health policy experts claim will make life more convenient for patients, improve care and save the NHS money. The changes will lead to some hospitals closing, warned the pro-integration NHS Confederation, which represents hospitals and other major NHS employers.
The prime minister has been persuaded by senior doctors and Downing Street health advisers that, without integration, the NHS could become unsustainable due to rises in the number of patients with long-term health conditions such as obesity, diabetes and breathing problems. The first move towards creating joined-up services is likely to see Lansley tell the NHS that it has to give integration the same priority that keeping waiting lists under control has had for the last decade.
That new target is the key recommendation of a new report on integrating care by the King's Fund and Nuffield Trust health think-tank's, whose chief executives both advise Downing Street. They want the introduction of "a clear, ambitious and measurable goal to improve the experience of patients and service users, and to be delivered by a defined date. This goal would serve a similar purpose to the aim of delivering a maximum waiting time of 18 weeks for patients receiving hospital care."
The new duty would oblige providers of medical care to start working closely with social care providers in order to streamline the care patients receive, ensure they have to deal with fewer organisations and departments and deliver more care in community settings rather than hospitals.
Cameron is also keen on the other suggestions in the report, according to well-placed NHS sources. They include new guarantees that patients will receive an agreed care plan and a named case manager responsible for co-ordinating care for all their needs, and changes to the existing "tariff" system – where hospitals are paid for providing episodes of care – to favour the planning and delivery of ongoing programmes of joined-up care for people with complex health and welfare needs.
The confederation's deputy policy director, Jo Webber, said: "Integrating care will improve services, particularly for people who are frail and those with long term conditions. But it will also involve making some really difficult decisions as hospital activity is reduced and moved into the community. Integration will take a long time to bed down and start improving the quality of care patients receive. Integration will produce more sustainable models of care in the long term but many local initiatives could mean new services being run in tandem while old ones are shut, which could be more expensive in the short term."
In addition, "fundamental reform of social care" – which the charity Age UK said was "an absolute disaster" – was vital, otherwise integration would not work, Webber said. Achieving joined-up services "will require significant political courage and leadership." Health and social care is already integrated in Northern Ireland and a few parts of England, such as Torbay in Devon, and patients generally report greater happiness with their care where it exists.
The care services minister Paul Burstow said: "Integrated care should be the norm. That's why we asked the NHS Future Forum to specifically work on the issue. Our ambition for the NHS and social care is a simple one – to achieve better results for people and carers. So our priority is to orientate the whole system around patients, service users and carers through our Outcomes Framework."
Andy Burnham MP, the shadow health secretary, backed the report and said it was further proof that the government should drop its health and social care bill, which would set back the cause of integration by 10 years.