Comment

12.12.18

Breaking down barriers to integration

Source: NHE Nov/Dec 2018

Anne Marie Morris, member of the Public Accounts Committee (PAC) and MP for Newton Abbott, outlines the committee’s recent report on the barriers to integration.

The PAC’s recent report into the interface between health and social care found that financial pressures on the NHS and local government make it difficult for them to work together to transform services. As local authorities and the NHS operate in different ways, it can be difficult for them to understand how they each make decisions and coordinate properly. This comes at a cost to the long-term health and social care needs of the population in England.

The concept of ‘integration’ is hardly a new phenomenon in the health and social care sector. Better joint working between health and social care has been a government objective since the Health Act 1999, but progress has been patchy – partly because it is difficult to achieve, and partly due to shifts in policy focus. There have been 12 white papers, green papers and consultations, and five independent reviews and commissions later, nothing has really changed.

One aspect that requires fixing is the current structural and cultural barriers that prevent the joining-up of services between health and social care. Such barriers between local government and the NHS can get in the way of a ‘whole-person’ approach. Other barriers exist in the form of current legislation in which the health and social care sector must operate. The Health and Social Care Act 2012, as The King’s Fund has pointed out, does not make partnership working easy, as it was designed primarily to promote competition.

An example of integration good practice is in Greater Manchester, where NHS commissioners and local authorities are forming single commissioning functions to cover the CCG and local authority. However, different areas of the country present different complex sets of requirements, and just because integration appears to be gathering pace in Manchester does not mean that it would necessarily work elsewhere.

Fundamentally, the needs of rural communities, such as in Devon, are different to those of large conurbations such as Greater Manchester, which tend to have younger populations and vastly greater access to services. Both the Department of Health and Social Care and NHS England recognise that it is a complex dynamic. Some organisations are working in partnerships covering different geographical areas, making it easier to build consensus, plan commissioning and delivery, and develop appropriate governance structures.

The first step toward tackling integration issues is the workforce. We have to address the issues around social care being an unattractive work option for people, and being seen as a workforce suffering from low pay and low esteem. As the Health Foundation pointed out in its evidence to our committee, a staff turnover rate of 25% in the social care sector adds significant challenges. Jobs in the social care sector need to be seen as an opportunity rather than a stepping stone.

We also need to look at the workforce that exists at a local level and how it covers both health and social care. District nurses play a vital community role, especially in rural communities – yet the number of district nurses has fallen by 26%, making them a scarce resource.

The committee was clear that financial pressures facing health and social care are a serious barrier to integration plans, and we have called on the government to set out a costed 10-year plan for social care to work alongside the forthcoming 10-year NHS plan.

If the government is serious about integrating health and social care, it must recognise and tackle all the barriers that services currently face and it needs a clear plan now.

 

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