The Independent View: Mutuals can deliver the integration needed to save the NHS

nhs sign lrgDelivering free at the point of use healthcare is rightly at the heart of the NHS. But faced with an ever-ageing population, a rise in long-term conditions and tight health budgets, radical reform is imperative to ensure the survival of our health system as we know it.

It is the rise in long-term conditions that is causing particular strain. Ranging from obesity and diabetes, to cancer and dementia, these complex and multivariate conditions affect 15 million patients in England and account for 70 per cent of total NHS spend. The NHS, designed to combat acute conditions, does not have the capacity to deliver the on-going care needed to treat these conditions in the right setting and in a cost effective manner. Worryingly, the rise such diseases, combined with fiscal constraints, could result in a £19 billion funding gap for the NHS – certain bankruptcy.

It is widely agreed that the key to meeting these challenges lies in taking an integrated approach to healthcare delivery. By taking this avenue, service providers can co-ordinate and deliver the right type of care in the most appropriate settings, whether this is in the hospital, at home or in the community. This will provide the on-going care needed for long-term conditions, reduce the strain on Accident & Emergency departments and place the NHS on the road to sustainability.

The Government is aware of this and has made promising moves towards integration. Last year Norman Lamb MP, Minister of State for Care and Support, launched fourteen pioneering initiatives to showcase innovative ways of delivering co-ordinated care. Their aim is to make health and social care services work together more efficiently and reduce the burden on emergency services.

This is to be commended and is undoubtedly a step in the right direct. However, taking into account the consensus surrounding the need to move towards an integrated health system, the Department of Health must develop more ways of achieving this and make it a top priority.

In our latest report, launched in Parliament yesterday, we argue that integration can be achieved by embracing mutualism, specifically, friendly societies. By their very nature democratic and benevolent organisations, we propose a model that Clinical Commissioning Groups contract friendly societies to deliver integrated pathways of care for those with long-term conditions. This would reduce the strain that long-term conditions place on the NHS, and provide the patient with integrated care in the most appropriate setting thereby delivering much needed savings.

Many friendly societies currently offer this service and we believe that it should be one of the avenues explored by the Department of Health as they re-shape the NHS. By adapting our model, service integration can be achieved without adding any new structures and producing cost effective results.

Talk about the benefits of integration needs to develop into how to make plans to deliver it. In Power to the People: The mutual future of our National Health Service, we are certain that mutuals are one way in which it can.

* David Fagleman is a researcher at ResPublica

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This entry was posted in The Independent View.


  • Jayne Mansfield 9th May '14 - 9:50am

    Will this be the ‘Big Society’ in action?

  • “Delivering free at the point of use healthcare is rightly at the heart of the NHS.”

    Generally agree with the mutual principle, but the last six words of that sentence make my heart sink. The NHS has become a sacred cow and it seems impossible to have a reasonable debate about healthcare in this country without being accused of wanting to ‘destroy the NHS’. It would be nice if we could move the debate on, and agreeing that free healthcare is the prime concern, but who delivers it is up for debate.

  • Jayne Mansfield 9th May '14 - 1:51pm

    @ Will Mann,
    Will, in 2010 the Kings Fund produced a document ‘ Big Society,political philosophy and implications for health policy’, which raised the question would mutual models lead to the excessive bureaucracy that the the ‘Big Society’ was supposed to overcome. The document can still be googled on the internet and I don’t know whether the question has been addressed.

  • Richard Dean 9th May '14 - 9:47pm

    In essence this seems like simple outsourcing. But if we’re going to go the outsourcing route, why limit it to friendly societies? Are they particularly well-managed, particularly competent, or particularly efficient? There could be other enterprises that might offer an equivalent service cheaper.

  • David Evans 9th May '14 - 10:58pm

    Richard is right. I remember democratic, benevolent mutuals like the Co Op; Grays Building Society or the Leeds Credit Union. I just wonder if Think Tanks are so shallow as to propose these sorts of bodies in their papers primarily because they sound nice.

  • Jayne Mansfield 9th May '14 - 11:20pm

    Aren’t Foundation Hospitals ‘mutuals’?

  • Eddie Sammon 10th May '14 - 12:05am

    There needs to be clear legal differences between companies, mutuals, charities, social enterprises, public sector bodies, NGOs, Quangos and whatever other institutions people are using. The lines are blurred and it is confusing.

    In my experience mutuals are either not very different to private companies or not very different to public sector bodies. This needs to change if they are to gain support and have a future.


  • Stephen Donnelly 10th May '14 - 1:28pm

    This is just wishful thinking by Respublica. Removing shareholders does not remove self interest. Who controls the mutuals? I fail to see how this would reduce cost and solve the funding crisis, or deliver the care the people need. It may work well for small groups of self interested parties who can gain control of the mutuals.

    I should be clear that the Lansley reforms, shamefully supported by the liberal democrats, are no better. They hand commissioning over to untried and unaccountable state bodies, and scores of clinical commissioning groups dominated by GPs with producer interests.

    The best system gives power to (consumers) patients in the form of a free choice. Anything else just entrenches vested interests.

  • Andrew Colman 10th May '14 - 3:42pm

    The NHS is one of the most efficient healthcare systems in the world delivering more per £ spend than most other systems, (Americans pay double about £3000 per head extra, for the same level of care on average). The NHS sis efficient because of its collective nature, it can negotiate low prices from drug providers for example. In contrast, in the USA, where healthcare companies exploit and profiteer out of sick individuals

    The answer for the NHS is to move back towards a single collective , thus reducing bureaucracy and marketing costs. Secondly, we need to raise extra revenue as demand increases due to more older people & more treatments. This requires tax increases, there are many potential sources eg Taxing overpriced land through land value tax, abolishing higher rate tax relief, higher inheritance tax , higher stamp but and if these don’t deliver higher income tax (but I am confident Land Value tax and tax relief abolition would deliver sufficient revenue)..

  • Jayne Mansfield 10th May '14 - 4:36pm

    @ Stephen Donnelly @Andrew Colman
    Spot on.

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