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King's Fund report outlines how health and social care should be transformed 

Full text from the Health Policy Digest Commentary summary issue 102

Transforming the delivery of health and social care

The King's Fund, 6 September 2012

The premise of this report is that there is strong evidence that the current health and social care system is no longer fit for purpose and requires radical transformation if it is to respond to demands. Demographic change is cited as the most significant challenge, with a growing number of older people, living longer but spending more of years living with ill health, as the burden of disease has shifted away from life-threatening diseases to longer term conditions. Combined with rising patient and public expectations in terms of quality, choice and convenience of care, the King's Fund proposes a change of emphasis to:

  • preventing illness and tackling risk factors, such as obesity, rather than a focus on treating ill health
  • shifting from "cottage industry" model of general practice and improving standards of primary care to enable more services to be delivered out of hospitals
  • broadening the range of alternatives to residential care, including new forms of care and people's homes and expanding the stock of specialist housing in the community
  • making more effective use of community health services and related social care, and improving access and availability of these services
  • shifting care for frail older people and people at the end of life to alternative settings
  • improving quality of care in hospitals through further concentration of specialist care in hospitals and more effective use of senior medical staff at weekends and evenings
  • integrating physical and mental care and ensuring connections are made with other public services to support people's recovery.

The future system

The report asserts that a fundamental overhaul in the delivery of health and social care is necessary to meet future demands. The future system will need to:

  • empower patients and service users to be partners in care, involving them in the design of their care and providing them with support to self-care and manage their condition
  • promote the development of flexible teams of health and social care professionals, with the right mix of generalists and specialists
  • reduce overreliance on hospitals and care homes, by delivering care closer to home in integrated community facilities where possible
  • use information and communication technology to improve access to care and foster self-care through telehealth
  • systematically identify and assess new technology and medical advances, promptly adopting those of proven cost-effectiveness
  • give control of data about their health and care to patients, which can be accessed and analysed in real time by health professionals.

The King's Fund argues that this will only become a reality if: outdated models of care are decommissioned to allow new ones to be established; innovation and adoption of best practice is supported; and the entry of new providers is facilitated where appropriate. Central to this approach is ensuring commissioning focuses on outcomes of care across the whole pathway or system of care, to enable joint working and improvements in quality.

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