As I write this, social care has been all over the news, again. There’s a continual stream of stories about the NHS and A&E, how targets are being missed and how the lack of social care is contributing to that. Amongst the stories was a report from the National Audit Office (NAO) stating that progress with integration has been slower and less successful than expected. Added to that, it hasn’t delivered anticipated benefits either.
This isn’t surprising. Breaking down the barriers between health, local authorities and social care is hard. Sharing budgets, leadership and thinking is even harder.
Better Care Fund
In 2013, the Government announced the £5.3bn Better Care Fund, to integrate health and social care. The Local Government Association called it, ‘one of the most ambitious programmes across the NHS and local government to date.
‘A local, single pooled budget to incentivise the NHS and local government to work more closely together…around people, placing their wellbeing as the focus of health and care services, and shifting resources into social care and community services for the benefit of the people, communities and health and care systems.’
However, the NAO report highlights just how little it has achieved against expectations. It found that the Fund has not achieved the expected value for money, in terms of savings, outcomes for patients or reduced hospital activity. Nationally, the Fund did not achieve its principal financial and service targets over its first year. Planned reductions in rates of emergency admissions were not achieved, nor did the Fund achieve the planned savings.
Compared with 2014-15, emergency admissions increased by 87,000 against a planned reduction of 106,000, costing £311m more than planned. Days lost to delayed transfers of care increased by 185,000, against a planned reduction of 293,000, costing £146m more than planned.
Other results include: local areas aren’t on track to ‘achieve the target of integrated health and social care by 2020…NHS England’s ambition to save £900m through introducing seven new care models may be optimistic and the new care models are, as yet, unproven and their impact is still being evaluated.’
However, progress is being made. The Fund has incentivised local areas to work together. The report says that, ‘more than 90% of local areas agree or strongly agree that delivery of their plan had improved joint-working. Local areas also achieved improvements at the national level in reducing permanent admissions of people aged 65 and over to residential and nursing care homes, and in increasing the proportion of older people still at home 91 days after discharge from hospital into reablement or rehabilitation services.’
I think we all agree that integration is the way forward and a dedicated pot of money is great, but when the sector is fire-fighting daily, all the work undertaken to integrate services and try to make savings isn’t going to have a huge impact.
The report also says that local government hasn’t been that involved in sustainability and transformation plans. It states that, ‘local authorities’ engagement has been variable, although four sustainability and transformation planning areas are led by local authority officials.’ Barriers include ‘misaligned financial incentives, workforce challenges and reticence over information sharing.’
Regular readers of CMM will know that it’s been difficult for social care to be involved in integration. Debbie Sorkin regularly writes on this, exploring how social care can get involved and why it must. However, if local authorities aren’t included, what hope is there for social care? Is the NHS just talking to itself? That won’t solve anything; social care holds many of the answers.
Full integration of health and social care is necessary, but it needs time and resources, good leaders and change management. It won’t be achieved by 2020 and it certainly won’t be achieved whilst no-one is talking to each other and everyone is trying to fight their daily battles.
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