Thread by @rcolvile

Have written my column on a hugely important new @CPSThinkTank report, which raises the alarming prospect that the NHS could be in for a repeat of the Lansley debacle. Quick thread on thesis/findings. thetimes.co.uk/article/minist…

The immediate problem for the NHS is money. There are still Covid patients taking up a chunky (and increasing) proportion of the bed base. And they need reduce capacity to do other stuff (because staff have to get in and out of heavy-duty PPE, patients need to be isolated etc)

On top of that, Covid has seen waiting lists soar to 5m - which @sajidjavid warns could hit 13m. And then there's social care to fix. So clear that £££ is coming/needed.

But in the broader sweep, the health and care system's demand for resources is essentially inexhaustible - Covid only adds to existing pressures from ageing population. That's why we're about to witness the biggest NHS reform in a decade - integration.

Integration basically means joining up the whole system - public health, GPs, hospitals, councils, social care. Healthier population -> fewer people in hospital. More joined-up care -> less bed-blocking. Better care, more efficiency, lower costs.

But here's the problem - a new @CPSThinkTank report, out today, shows that it's not working. In Manchester, the testbed/poster child for integration, 'delayed transfers of care' (ie people stuck in hospitals waiting for care beds) were 65% higher post-integration (vs 9% baseline)

Overall, as this table shows, care in Manchester seems to have got worse under integration, not better (measured by outcomes, productivity etc). And they got £450m to make it work!

The response within the NHS has been, essentially, to dump on @AndyBurnhamGM. The argument is that Manchester's problem is the local leadership. Integration is still a good idea more broadly. But but but...

Our report then looked at West Yorkshire, which is closer to the model for what's going to happen nationwide - the Integrated Care System (ICS) is run by the NHS, not local politicians. Results were better, especially on bed-blocking. But not THAT much better.

In fact, of the 42 'ICS regions' that England has been sliced up into, we could find no evidence in the 13 pilot areas of sustained improvement in outcomes. (Admittedly, it's still early doors. But you'd hope there'd be at least SOME sign it's working.)

(I should clarify - it's not just us saying this. The NAO published this report in 2017 that said, very loudly, THERE IS NO EVIDENCE THIS IS WORKING. And Scotland, where it's already been done, is having significant teething troubles.) nao.org.uk/report/health-…

I should clarify here: we are not saying integration is a bad idea. It makes obvious sense! But in both GM and West Yorks, it has led to lower productivity and way more bureaucracy - perhaps because joining up all these competing bureaucracies turns into a carnival of committees

Perhaps the most depressing thing about this saga, however, is the response of @NHSConfed to our report. Their press release, here, is a masterpiece of avoiding the issue. nhsconfed.org/news/delaying-…

They say there are 'many examples up and down the country' of how integration is delivering 'measurably better' outcomes. We give some! But they, er, don't.

They also say that we only looked at delayed transfers of care, and that we are 'ignoring the fact that many local integrated care systems have improved their performance on this measure'. Yes, many have. But the ICS average from 2016-2020 is up 24% on 2012-16, vs 9% for England

And that includes some truly lamentable/alarming performances, including Greater Manchester's.

And we don't just look at delayed transfers of care! We look at A&E admissions, which are flattering to the ICS model. But alcohol-related conditions very much aren't!

Here are the other indicators we looked at, in case of interest. Again, very hard indeed to argue that being integrated is doing anything in particular to improve these outcomes, vs other factors unique to that area.

You can find the full report here. But ultimately, there is one simple argument to make. If you are going to reorganise the entire NHS - esp at a time when it is facing so many other pressures - you really need to present rock-solid evidence it will work. cps.org.uk/research/is-ma…

Instead, as I say in my column, we're essentially taking a great big dose of faith-based medicine. Please give it a read thetimes.co.uk/article/minist…

Oh, one quick point on Lansley comparison. The NHS line is that moving commissioning power from CCGs to ICSs will save money by stripping out a layer of bureaucracy. Which was exactly the line Lansley used in replacing primary care trusts with CCGs! Same people, different chairs.

PS This is the first report for us by @MalvernianKarl, but definitely not the last. Please give him a follow if you liked it.