Effective Approaches to Integrating Care: A Three-Part Series.

This issue of Healthcare Quarterly introduces a three-part series featuring international perspectives on health service delivery models that improve system integration and ensure seamless services and better coordination. The series, developed by Ontario's Change Foundation, will feature Chris Ham, chief executive of the London-based King's Fund think tank; Geoff Huggins, director for health and social care integration in Scotland; and Helen Bevan, chief transformation officer of England's National Health Service.

Think tanks and health policy in the United Kingdom: The role of the King's Fund.

The King's Fund is a long-established health policy think tank involved in work on evidence-based policy in the United Kingdom. There have been few accounts of how think tanks operate. This essay seeks to partially fill that gap by reviewing the work of the Fund between 2010 and 2018, when the author was its chief executive. The essay outlines the history and status of the Fund, its funding and staffing, and the range of activities undertaken. Examples of policy areas in which the Fund was active and its impact on both policymakers in central government and leaders working in the National Health Service are discussed.

Reforming the NHS in England: opportunities and challenges.

This paper reviews the main challenges facing the NHS in England. It assesses the radical reforms proposed by the coalition government and the financial pressures facing the NHS. The paper argues that much more emphasis needs to be given to integrated care in future in the context of an ageing population and the increased prevalence of chronic diseases. The importance of effective leadership in the NHS must be recognised and supported and is likely to be one of the issues highlighted in the Francis Inquiry report into Mid Staffordshire NHS Foundation Trust. There is also a need to look beyond current debates on reform and funding and ask what kind of health and social care system is required in the future. The King's Fund's programme of work on the future system will be raising major questions about the current emphasis on hospital based care and the need to reorient towards supporting people in their own homes and in community settings.

World class commissioning: a health policy chimera?

The health reforms in England have entered a phase in which greater emphasis is being placed on market-like mechanisms. The ability of the commissioners of care to negotiate on equal terms with providers will be of critical importance in the emerging market. The government has set out plans to develop 'world class commissioning' and this essay reviews experience in Europe, New Zealand and the United States to understand what is involved in working towards this goal. The evidence reviewed shows that in no system is commissioning done consistently well and highlights the obstacles to the development of world class commissioning. The reasons for this centre on the complexity of health care and the inherent difficulty of commissioning health services in publicly financed systems. Commissioners will need to be able to access a range of expertise and are likely to incur significant expenditure in so doing. There are warning signs from other systems of health reforms that result in adversarial and legalistic approaches, and do not give sufficient attention to relational contracting. Even if world class commissioning is developed, it may fall short of its potential in the absence of other changes in the design of the reforms, such as autonomous providers and appropriate payment systems. In view of these challenges, a more promising alternative would be to develop competing integrated systems.