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NAO: Health and care integration undermined by underfunded NHS and councils

In anticipation of the social care funding green paper, now delayed until autumn, a new report published today by the National Audit Office (NAO) has called for further and faster progression towards an individual-orientated, integrated service to ensure better value for money and to meet growing demand for care.

The report argues that if health and social care organisations are to fully adopt integration, then funding, commissioning and payment arrangement must incentivise them. Integrated care systems are one way of doing this, the report says.

Despite protecting spend on social care, local authorities have had to reduce care spending by 5.3% between 2010-11 and 2016-17. With health, the NHS faces growing demand, which has seen funding per person increase by just 0.9% on average between 2013-14 to 2018-19.

The report argues that because organisations struggle with their own viability, this increases the risk of unhealthy competition and a culture of blame when things go wrong, rather than encouraging collaborative integration.

Despite these financial pressures, the report found that new job roles and new ways of working could help to support more integrated, individual-focused care, but argued that this is difficult to implement because of the divide between the health and social care workforces.

Amyas Morse, the head of the NAO, said: “No one across government or the Civil Service would disagree that health and social care have to be in balance to give people quality of life, and to use the available national and local resources as efficiently as possible. The hard part is agreeing how that balance is to be achieved and maintained, and who is willing to sacrifice what to bring it about.

“The NHS did not like funds being syphoned off through the Better Care Fund, whilst local government has reservations about sacrificing over half of its financial resources towards NHS England’s priorities, which risks eroding local democracy.”

The answer may therefore lie in local flexibility, Morse argued, adding: “But that could leave serious gaps in delivering what is needed – an integrated service. Serious political leadership is needed.”

Responding to the report, the head of strategy at NHS Providers, Miriam Deakin, commented: “The NAO report recognises that social care and the NHS are two sides of the same coin.

“Years of cuts to local authority budgets have led to a significant squeeze on adult social care. The knock-on effect has been felt right across the NHS, including hospital, community, mental health and ambulance services.

“We need a clearer national strategy for joined-up health and social care services which supports people to stay well for longer and brings care closer to home.”

Top image: rajurahman85 via iStock 


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