Contracting for integrated health and social care: a critical review of four models

In the current climate of service reorganisation and sensitivity surrounding cost, it is clear that commissioners and providers in the health and social care economy are striving to strengthen

integrated care as a means of improving quality and reducing costs (Curry and Ham 2010; Ham and Walsh 2013). Across England, health and social care systems are having to confront many pressures.

For example, most of the funding is tied up in acute and long term social care, current NHS contracts are widely regarded as insufficient for the transformation agenda with block contracts stifling innovation, and Payment by Results does not incentivise the reduction in admissions or social care changes but in fact acts as a perverse incentive (Curry et al 2011). In addition, Advanced Assistive Technology should be embedded within integrated care but is often peripheral. As a consequence, commissioners must rapidly consider commissioning and contracting

arrangements to enable them to drive forward service integration that is innovative, sustainable and transferable. Recently, there has also been support from NHS England Chief Executive Simon Stevens for promoting more flexible approaches to commissioning and contracting, strongly suggesting that CCGs could explore alternative approaches. These ideas have become more formalised in NHS

England’s Five Year Forward View, with Multi-Specialty Community Providers (MCPs) and Primary and Acute Care Systems (PACS) eventually evolving to hold a delegated budget for the health and

care of whole populations (NHS England 2014). These new integrated care models require strong relationships and trust between the different organisations and professionals delivering care, which

should be underpinned by sound contracting mechanisms that have relational concepts embedded within them. However, there is currently scanty evidence on contracting approaches that would

have a good fit with the transformation agenda, particularly concerning how agencies can work towards joint outcomes. This paper presents the findings of an international literature review of contracting approaches, models and designs, with the aim of critically analysing their suitability to the integrated health and social care agenda. An important feature of this was to capitalise on learning from agencies and industries external to our health and social care systems and to identify in particular evidence of effectiveness and what could be usefully be transposed. The approach and search strategy of the literature review can be found as an appendix.