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Into Perspective: Integration

Integration has been a buzzword in adult social care for some time, with many backing the move to join-up health and social care. But with COVID-19 having somewhat forced the issue, is it what the sector really needs?

Do we really want ‘integration’ in a post-COVID world?

In last month’s CMM, John Kennedy asked, do we really want integration? His point was not that services shouldn’t work together, but that we might be approaching this wrong.

The idea behind integration is to enable both the health and social care sectors to work seamlessly together. This should support better pathways for people engaging with services, more shared information between health and care, and ultimately improved outcomes for everyone.

The initial issues

In principle, it seems like a good idea, but it has brought about challenges when being put into practice. The NHS Five Year Forward View, published in 2014, set out the importance of bringing the sectors together, giving examples of work already happening in hospitals and care homes that was improving experiences of care and removing burden from both services.

However, as early as 2016, Tom Buckley wrote for The King’s Fund that, ‘Pressures on health and social care have been growing year on year, with most providers now in deficit and key patient care targets being consistently missed,’ adding, ‘The main challenge of implementing the Forward View is to balance the urgent need for change with the pace of implementation.’

The more recent NHS Long Term Plan again mentioned the need for a more joined-up approach – although many at the time felt that this was a missed opportunity to create a joint plan for the future, as was the case for the NHS People Plan, which again deepened the trench between the two sectors.

Progress is being made

In spite of the difficulties, new systems and models have emerged that continue to make a difference.

We have seen the advent of sustainability and transformation partnerships (STPs), which were intended to bring together various services to share resource and ideas, and integrated care systems (ICSs), which see leaders take collective responsibility to improve the health and wellbeing outcomes and systems for the local community.

Care providers now have access to NHSmail and large NHS organisations are beginning to raise their voices to say that social care must be prioritised.

How has COVID-19 changed things?

While progress has been happening, it has historically been extremely slow. Information sharing and equal respect have been difficult to establish, but the COVID-19 pandemic forced things to change rapidly.

Suddenly, hospitals were forced to share patient information with care providers, and care providers had to work with local health services to protect the people who used their services.

However, the change has made people question what we are doing to ‘integrate’ health and social care. More and more are agreeing with John, that we are approaching it from the wrong angle and that actually things could be much simpler. Our experts share their thoughts.

Reform is a pre-requisite for a functioning NHS

While the NHS Confederation has highlighted transformative work brought about through COVID-19, the pandemic has certainly exposed some structural flaws in our health and care system. As we look ahead to the long processes of recovery and reset, as well as the prospect of new NHS legislation, now is the time to address them.

For too long, social care has been the neglected sister service of the NHS, starved of attention and resources and always seeming to fare worse than its healthcare sibling.

It is high time social care ceases to be an afterthought and becomes more integrated with health – and not simply in name only.

Reform is not only essential if we are to support some of the most vulnerable, it is also a pre-requisite for a functioning NHS. We know much activity in the acute sector comes from older people with long-term conditions who have become acutely ill.

This will always happen, but we also know effective management and support from community and social care services, often joined up to secondary care support, can reduce admission rates and keep people healthier for longer in their own homes throughout their lives.

Our members – NHS leaders across England – have made clear we also need a national, integrated health and care workforce strategy to address a workforce that is under-trained, underpaid, and overly reliant on agency staff.

There is not only a workforce shortage in social care, with more than 100,000 vacancies in the sector, but a shockingly high turnover rate, equivalent to about 440,000 leavers a year.

We know we need a short-term injection of funding for social care, particularly in the wake of the pandemic, as well as long-term funding to secure its future, and a long-term plan. We also need a new framework for delivering care.

This will require careful consideration about the relationship between health and social care, and political courage.

The details have yet to be worked out, but a long-term settlement for social care will be essential for the stability of the sector.

Dr Layla McCay, Director, NHS Confederation


We must focus on those in need

It is true that the COVID-19 pandemic has exposed some of the fault lines between health and social care and, in the future, we need to use this experience to identify what we need to consolidate, as well as what we need to change.

We need to be bold in our aspirations and clear about how these two systems will be funded, staffed and respected in the future.

In creating our vision for the future, I want to reclaim the term integration.

All too often there has been an assumption that integrated services require organisations to be merged, this is not necessarily true.

Real integration should be measured by the experience of people who use services and in future we need to use this as a measure of success.

There are good examples of different organisations that work co-operatively and deliver a seamless experience.

The airline industry is a good example of this.

When I sit on a plane, I do not know when I leave Austrian airspace and go into German airspace.
A massive administrative process is going on in the background, but what I experience, despite the involvement of many different organisations, is a flight from A to B.

One of the things that has been made clear in this pandemic is that we should not have focused on organisations, rather we should have looked at those in most need.

We need to plan, develop and deliver services that are focused on people and outcomes, and not on organisations and processes.

Professor Martin Green OBE, Chief Executive, Care England


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