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The Health Service Journal website carries an article expressing mild disappointment that the 16 integrated care pilots announced by the Department of Health do not go far enough.

The article questions the level of innovation in the scheme and its scope, since each of the pilots covers an area smaller than a single PCT population.

This supposedly cautious approach is contrasted with that of Kaiser Permanente, the US organisation widely considered to be a model for integrated healthcare.

When the integrated care scheme was mooted last summer in Lord Darzi's next stage review it was widely hailed as radical because it promised to model healthcare provision around the needs of the patient. More than a hastily concocted mission statement or vague aspiration, the idea had some radical consequences: putting a single provider organisation in charge of the entire care pathway was one of them; eroding the distinction between primary and secondary care another. A third and potentially even more radical outcome was the blurring of PCT boundaries. Integrated care organisations positioned across PCT demarcation lines rather than neatly within them would prevent cosy monopolies from formin within familiar commissioning domains.

But leaving the politics and business to one side, the fundamental and central point of integrated care is enshrined in the name. The idea that responsibility for all of a person’s healthcare needs could be concentrated in one place rather than be shared, fudged or fumbled between loose federations of providers was too good an idea to ignore.

Like all pilot schemes this one will face problems of evaluation. Deciding what really worked will be hard. Deciding whether it can work elsewhere or on a bigger scale will be harder still.

This isn't the X Factor: the idea isn't to end up with a single winner, but to identify viable alternatives.

The 16 schemes selected have been chosen for their variety. From the outset, the idea was to try a number of different models of vertical and horizontal integration – the clue is in the word 'pilot'.

Before we write off the integrated care pilots, it would seem only reasonable to give them the chance to get off the ground.

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