Health and care integration will not happen unless budgets are pooled
The desire to see integrated heathcare and social care services is broadly shared by care professionals, government bodies and special interest groups. But in England, successful integration is only found in local initiatives that focus on specific areas of care or patient groups. These successes are driven by joint working between local authorities and health trusts, plus third-sector organisations, and are to be commended; not least because they have generally been achieved despite national funding mechanisms working against them.
The Better Care Fund of £3.8bn was enhanced by additional voluntary contributions, bringing the fund up to £5.3bn, and has helped to support a number of local integration initiatives. The chancellor also used November’s spending review to promise a further £1.5bn for the fund in the two years to March 2020. But in a survey of local authority care directors by Health MJ and BT, almost half (43%) said they believe the Better Care Fund has had little or no impact on care budgets and service quality.
In the summer of 2015, the King’s Fund report Options for Integrated Commissioning added further weight to the argument for a single pooled budget in every local area by 2020. The paper recommended ceding control of the national budget for social care to the Department of Health. The thinktank examined the financial viability of the healthcare system and determined that health and wellbeing boards are not fit for this role in their current form. The report suggested that every local commissioning arrangement should have the same aims and desired outcomes. And it also recommended legislation to enable health and wellbeing boards to take over health and social care commissioning.
Full integration of healthcare and social care would, on face value, appear to be the logical way forward. It’s not without precedent; Northern Ireland took that direct approach by bringing together services into five regional health and social care trusts in 1973. However, while reorganisation in various forms has been mooted, particularly by politicians in the lead up to the last election, significant reorganisation is unlikely to be embarked upon given the turmoil in the NHS created by the reforms instigated by Andrew Lansley.
There are a number of major obstacles to full integration: differences in pay scales between the NHS and local authorities would force costs upwards and healthcare budget deficits would create further pressures on, and likely damage, local authority services.
Health MJ and BT’s survey of local authority care directors also showed they believe technology helps deliver a better quality of life for users for community-based services, while also helping with budget pressures and rising demand. In its response to Simon Stevens’ Five Year Forward View, techUK launched its interoperability charter, setting out key principles for IT suppliers, the NHS and local government to sign up to in order to change services.
More recently, frontline clinical information leaders across the NHS made the Newcastle declaration, calling for a change in information sharing between different electronic systems. Lack of access to service user and staff records, and incompatibility of systems across different services, is a barrier to joint working, so better information sharing is key in integrating health and social care.
The three largest regional health and social care trusts in Northern Ireland now use a common electronic patient record system to support integrated community services. This is complemented by the electronic care record so information can be shared with clinicians and care workers across different settings. Shared access to patient and client data and common working processes is essential to making information available in the right place at the right time to support the best care.
Different funding streams are a hindrance to integrating health and care services – and recognition of this fact must lead to actions that bring the different streams together.Northern Ireland has adopted one clear approach, the King’s Fund recommends another, and a single care budget will underpin Manchester’s devolution programme. With 37 local organisations (as well as NHS England) to be represented on the strategic partnership board that will start work in April, Greater Manchester has the chance to demonstrate that shared aims supported by a single budget can lead to better outcomes for people.
David Roots, Executive Director, Health & Care