Funding holes crippling 'urgent' health and care integration plans

Key health and social care bodies have set out their vision for how services can be integrated by 2020, but warned it’s at risk because of funding shortages.

‘Stepping up to the place: The key to successful integration’ is a joint report from the NHS Confederation, Local Government Association (LGA), Association of Directors of Adult Social Services (ADASS) and NHS Clinical Commissioners which argues that local systems should embed integration as ‘business as usual’ in order to achieve it by 2020.

However, it says that service integration may not be possible until national leaders address the shortfall in funding, particularly in public health and community services.

Stephen Dorrell, chair of the NHS Confederation, said: “The NHS continues to face unprecedented demand and challenging financial circumstances.

“Against this background, we need to make sure we are utilising all the collective resources of a ‘place’ to benefit our local communities. There is now a real urgency to deliver on this ambition. Our priority now must be to turn rhetoric into action.”

The report also warns that full integration may not be possible because of the disparity in funding between the health service, which is free at the point of access, and social care, which is means tested.

Greater dialogue needed

It says that greater dialogue is needed between local political, clinical, commissioning and community leaders in order to begin action to implement integration.

This should include ensuring that local systems have the right level of accountability, resources and staff training to deliver the changes needed.

A recent investigation by NHE’s sister title, Public Sector Executive, highlighted that there is inconsistency in driving forward sustainability and transformation plans (STPs), which found that over two-thirds of councils were shut off from discussions to nominate an STP leader.

These arguably momentous plans, designed to integrate health and social care across 44 ‘footprints’, have also been watered down since their genesis. This week, life sciences minister George Freeman admitted that STPs have no legal basis and plans submitted in June will only “form the basis for discussion”.

The LGA’s community wellbeing spokeswoman, Cllr Izzi Seccombe, said that health and social care faces major financial and demographic challenges “meaning we have to change our model of support”.

“We believe a shared local vision based on local populations’ health needs, and developed with local leaders is the most effective way of using public resources to improve health and wellbeing,” added Cllr Seccombe.

The organisations will publish a self-assessment toolkit to help local system leaders judge how capable they are of delivering integration by next month.

Their vision for an integrated system includes creating personalised care plans to place the individual at the heart of services and allow them to address their own care, and preventing problems from developing by addressing wider issues which affect the health of the population and lead to health inequalities.

They also say that greater shared leadership is needed, potentially including co-commissioning health and social care services, reforming payment systems and ensuring a free flow of information.

Jane Dacre, president of the Royal College of Physicians, said the college fully supports the vision of a person-centred health and care system, where professionals work together for citizens and communities.

“This means new ways of working. But we also need investment. In the NHS, we are under-doctored, under-funded and over-stretched,” she said. “In our hospitals, we also see the impact of cuts in social care budgets, with vulnerable people too often bounced around a fragmented system. We need to move away from services that are planned in silos and look at one small part of a patient’s treatment, to joined-up planning across health and care.”

Dacre added that the new report from the NHS Confederation and LGA is a welcome step to realising this important aim.

“To make their vision a reality, we need to give frontline clinicians and their partners in social care the time and space to innovate, and the freedom and support to step beyond their organisation’s walls,” she added.

It is increasingly accepted that better integration of health and social care systems is needed to try to reduce the number of patients needing to use the NHS, which is at an unprecedented high at a time when the health service is facing a deficit which could reach £16bn by 2020.

This has led to the worst performance figures ever in key measures such as the number of A&E patients being seen within four hours the number of delayed transfers.

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Dr Rupert Fawdry   20/06/2016 at 09:39

A major priority in moving away from services dependent on incompatible silos and towards genuinely joined-up medical and social healthcare is for all of us to take seriously the recent comments by Professor Lilford (Director of the NHS National Institute for Health Research), that we need to halt "the near unmitigated disaster that current electronic records have become" His recent NIHR CLAHRC West Midlands News Blog starts "Everyone wants to go digital, it’s good, it’s modern, we must all be paperless. Welcome then to the Electronic Record. Great moves are underway to help hospitals to go paperless in England, the USA and elsewhere. But he continues “Well, if you think it's such a great idea read the recent Lancet paper by Martin and Sinsky. They provide a thoughtful and well-referenced account of the shortcomings of electronic records in hospital care. You will find it hard to think that clinical care is improved by such systems once you have read the article. On the contrary, the evidence points the other way - these things actually impede good quality clinical care. One (perhaps the) reason is that they have become subverted. Instead of providing an information system for clinical care in real time, they have been heavily adapted to serve another master - the quality control industry. We health care professionals promote evidence-based decision-making, yet we are allowing ourselves to be sleepwalked into a poorly evaluated but massive intervention. Such evidence as the article can reference suggests that, far from assisting good care, electronic records (in their current form anyway) are inimical to it. We do enormous and expensive trials to find out whether we can extend life by a few months in an uncommon disease, but we let this potential monster intrude in a near evaluation vacuum." His blog and the Lancet article should become compulsory reading for all those involved in this area. If going paperless is harming patient care, and more and more evidence is joining that way. How much greater is the cost and damage being done by the headlong rush to go electronic in our attempts to move towards integrated community care.

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