Integrated Care: Part Two

Integrated Care: Part Two.  Given those willing to endorse the term ‘integrated care’, our suspicions were that it was simply both code and euphemism for managed care. Confirmation of the long-term nature of such a process can be found in a journal called, appropriately, the Journal of Managed Care. The second issue, from May 1997, just after New Labour swept to power, reported on a symposium from the University of Birmingham. Among the contributions from consultants, managers and BUPA reps, Chris Ham, now Chief Executive of the Kings Fund, warned the delegates of the “potentially unhelpful language surrounding US managed care”. This he continued, “often gave negative impressions of market-focused imports from the US and in the new political climate in the UK alternative terminology would need to be found for the key principles of managed care”. The alternative suggested was of course integrated care .

Indeed the very next issue saw the journal rebranded as the Journal of Integrated Care, with the Royal Society of Medicine now willing to lend its weight as publisher. An editorial “assumed that ‘managed care’ would be a term that all health care workers would come to recognise as meaning a collection of tools and techniques with which to deliver health care that was both of the highest quality and affordable. However the term has seems to have acquired for many a meaning of external control, cost saving and, more than anything else, something undesirable coming from the US. In short, managed care has a ’bad name’”. The editorial added that “the Prime Minister had clearly been advised to avoid using the this term!” (Original punctuation) No doubt some of this advice came from Ham himself as one of the strategy directors within the Department of Health.

As Stuart Hall said New Labour always did speak with forked tongue, trying to conceal its continuity with the previous government with more progressive or technocratic sounding phrases and Third Way hogwash. But these were inevitably of a subaltern nature to market driven imperatives. The Conservative government had already experimented with HMO type set ups such as fundholding and a provider-purchaser split, and while New Labour insisted they did away with an internal market, this was never the case. It simply adjusted the mechanisms applied, and the term integrated care has proved a remarkably durable shell to accomplish this.

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