Labour backs down on hospital-led integration in 10-year NHS plan

GPs rather than hospitals could lead integrated care organisations under a Labour government, the shadow health secretary has suggested.

Andy Burnham: rethink on Labour integration plans (Photo: Alex Deverill)
Andy Burnham: rethink on Labour integration plans (Photo: Alex Deverill)

Andy Burnham set out Labour’s ambitious and wide-ranging 10-year programme for health and social care ahead of the general election in May.

The shadow health secretary, speaking to an audience of NHS and policy leaders, said integrated care organisations (ICOs) would be set up in every local health economy but would not have to be hospital-led, as he had previously suggested.

At Labour’s party conference in September Mr Burnham said every hospital trust would be asked to form ICOs with GPs at the centre, to expand into the community. Practices, he said, could in some places be swallowed up by the hospital-run organisations.

GP leaders expressed alarm following Mr Burnham’s party conference speech, with the RCGP warning hospital-led integration would ‘destroy everything that is great’ about general practice.

Single budgets

Under Labour’s revised plans, ICOs would integrate all local health and care services into a single organisation with a single budget ‘providing services directly or working through trusted partnerships’, Mr Burnham said on Tuesday.

However, he added that the NHS England Five Year Forward View had shown there are different paths and Labour would not now impose a particular model of integration.

The Five Year Forward View set out alternative models of integration: the GP practice-led 'multispecialty community providers', or the integrated hospital and primary care provider 'primary and acute care systems' model.

Mr Burnham sought to reassure GPs that his party's plans would not force practices to merge into hospital-led ICOs.

Salaried GP workforce

But he did again suggest that many of the 8,000 new GPs Labour plans to recruit could be employed as salaried doctors within the new organisations. 

It was also necessary, Mr Burnham said, to reduce the number of NHS organisations - to help integrate services and make savings. ‘We need to break down the silos and end those divides that hold us back: primary versus secondary care; physical versus mental health; NHS versus council.’

Under Labour’s manifesto plans Monitor would be given a new role to drive integration and unlock savings by reporting annually on the financial viability of local health economies. 

Mr Burnham insisted his plans would not involve another top-down, structural reorganisation. Decisions would be made locally and the ‘path to full integration and a single service’ was a 10-year journey, he said.

No structural reorganisation

‘The plan reaffirms our intention to work through the bodies we inherit, with no new structural re-organisation, but adding ambition and impetus to existing plans for integration.’

Mr Burnham confirmed council-led health and wellbeing boards would take a new role in commissioning alongside CCGs.

CCGs would remain, but the commissioning system would ‘evolve and grow’. But health economies would have to move away from clinical commissioning to social commissioning.

‘The point about the health and wellbeing board is we have to made a transition, a paradigm shift, from a medical or clinical model of commissioning to a social model of commissioning,' Mr Burnham said. ‘We must link health with housing and planning policy, education and leisure.'

21st century vision

He added: ‘We have to have a bigger vision of what commissioning for health might mean in the 21st century.’

Health and wellbeing boards will also oversee new year-of-care budgets, initially for patients at greatest risk of hospitalisation. These budgets would be paid to providers - with NHS organisations given preferred provider status - to encourage the service to integrate into the community and employ social care staff.

Labour would also reinstate the 48-hour GP appointment guarantee funded with £100m savings from abolishing competition regulations, and take on 8,000 new GPs using a £2.5bn 'time to care' fund.

The 10-year plan said Labour would consult on finding greater savings in the system.

Mr Burnham said Monitor had calculated that savings of between £4bn and £6bn could come from integration. That’s why, he said, ‘my message is go for full integration’. Those savings, he added, could come quickly.

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