Local focus to investment needed to resolve care crisis
In response to the NAO report into health and social care integration, Jos Creese argues that a fundamental rethink is needed, on which local government must be fully engaged
Once again, health and social care integration is in the news, with published research by the NAO and a statement from the chair of the Public Accounts Committee this week.
These are both helpful in raising the profile for the opportunity for joined up care systems, and the huge associated challenges. But they also make rather depressing reading, at least in terms of the continued apparent lack of pace and an absence of truly joined-up thinking about what integrated care should mean.
Many of the NAO findings have been echoed by local care providers and councils for some years. It is therefore particularly reassuring to hear Meg Hillier MP, chair of the Committee of Public Accounts, saying publicly that there needs to be more investment in community-based services, and that it is a mistake to focus investment on the NHS to the exclusion of social care. She notes, in particular, the importance of closer involvement of local public services and councils : “unless the Department of Health and NHS England fully engage local government in whatever rehashed targets result from sustainability and transformation plans, then integration by 2020 is nothing but a pipe dream”.
The solution to the care challenge in the UK must lie in tackling the problem differently - moving the emphasis away from the view that this must be solved through a primary care focus. Primary care naturally attracts the sympathy of the public, the concern of the press, and therefore the interest of politicians. It is also where the big money goes and where the most powerful vested interests lie, from suppliers to clinicians. But solving the pressure on hospital A&E departments, adult social care capacity, bed blocking and health care demand growth requires two actions:
- A higher level of investment in social care and health, immediately, to help to protect patients and those at risk. This is the penalty from decades of failed policies, under-investment and too many national initiatives not delivering (NHSIT, Connecting for Health, NPfIT, Care.Data, Better Care Fund)
- A fundamental rethink into how care services are structured, as defined in the recent Eduserv reports on this topic . This is about a total redesign, and that takes time and is not easy. It does not mean a massive government IT project, but it does require some bold thinking and some catalyst projects. It requires the agencies, departments, service leaders and politicians to act and think very differently about priorities and where their intervention and investment can be most effective.
Jos Creese is principal analyst at the Eduserv Executive Briefing Programme which has published two in-depth reports on the challenges of health and social care integration. You can download copies of both Health and Social Care Integration reports – Confronting the Challenges (Part 1) and The Potential of Digital (Part 2)