All together now: competitive integration in the NHS

Document type
Featherstone, Henry
Policy Exchange
Date of publication
1 November 2012
Health Services
Social welfare
Material type

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This report says that NHS funding arrangements encourage acute hospitals to admit patients to hospital to service high fixed costs for staff and property rather than trying to treat patients at a community level or in the home. It also finds that by international standards patients in England with chronic diseases are more likely to be admitted to hospital and stay much longer once admitted. Over the past twenty years, successive governments have divided the NHS into ever smaller and more divided parts. This has led a multi tiered system of separate organisations, each setting their own legal identity, culture and bonus schemes. The lack of coordination between Primary Care Trusts; GP practices, and acute hospitals has led to unnecessary and costly admissions to hospital for patients with long term conditions such as diabetes and Alzheimer’s who should be treated at a community level or in the comfort of their own home.

The report finds a common theme from successful integrated care organizations around the world is the alignment of doctors’ incentives which encourage GPs and consultants to work together. The NHS pay and performance system needs to move away from considering each professional group as an isolated case.