NAO: No compelling evidence that health integration really works

The government’s plan to integrate health and social care services across England by 2020 is at “significant risk” due to progress being slower and less successful than had been hoped, the National Audit Office (NAO) has warned.

The auditor advised that the Better Care Fund (BCF), the government’s main integration initiative, has not yet achieved its desired financial and service targets despite £5.3bn having been spent through the BCF last year.

And despite planned reductions in emergency admissions and delayed transfers of care, the numbers of both actually increased in 2015-16, costing the government £457m more than had been planned.

Sir Amyas Morse, head of the NAO, said: “Integrating the health and social care sectors is a significant challenge in normal times, let alone times when both sectors are under such severe pressure. So far, benefits have fallen far short of plans, despite much effort.

“The departments do not yet have the evidence to show that they can deliver their commitment to integrated services by 2020, at the same time as meeting existing pressures on the health and social care systems.”

The NAO found that while government departments have set up an array of initiatives examining ways to transform care, the models are as yet unproven and governance of these measures is poor. The watchdog thus argued that NHS England’s ambition to save £900m through seven new care models “may be optimistic”.

“It will be important to learn from the over-optimism of such plans when implementing the much larger NHS sustainability and transformation plans,” Morse added.

Most damningly, the report found “no compelling evidence” to suggest that integration will yet lead to financial savings for the NHS or reduced activity in acute hospital trusts.

“While there are some good examples of integration at a local level, evaluations have been inhibited by a lack of comparable cost data across different care settings, and difficulty tracking patients through different care settings,” it said. “The NAO today reiterates its emphasis from its 2014 report on the BCF that there is a need for robust evidence on how best to improve care and save money through integration and for a co-ordinated approach.”

Despite this, the auditor acknowledged that the BCF has been partly successful, such as in encouraging local areas to work together – 90% of these areas agreed that delivering the plan had improved collaboration between them.

Areas also managed to achieve a reduction in the number of elderly people being permanently admitted to care homes and an increase in the proportion of people being rehabilitated at home three months after their discharge from hospital.

Experts call findings ‘a wake-up call’

The findings of the report have been slammed by influential health think tank Nuffield Trust, which said the government’s plans to save money by shifting care into the community “are built on sand”. It stressed that the auditor’s report should serve as a wake-up call that quality of care will not remain unaffected in the face continued funding constraints.

“As the NAO finds, the evidence to support the assumption that billions of pounds can be saved by moving patients into the community simply does not exist, because there is so little data available on how much it actually costs to look after a patient out of hospital, making robust evaluation difficult,” argued Sally Gainsbury, senior policy analyst at the Nuffield Trust.

“What’s more, even if it did prove cheaper to treat patients out of hospital, those savings could only be realised if the freed-up wards or units were closed. With many hospitals currently running at over 95% capacity, the prospect of that happening looks remote.”

Clinicians were equally unsurprised by the report. The Royal College of Physicians said that financial demands and severe pressure on services have acted as a “barrier to transformation”, despite good collaboration between local authorities and NHS organisations.

“This background results in double jeopardy – not having enough staff and resources to introduce new parallel services to see if they can really work in integrating health and social care, improving patient experience and producing efficiency savings – and the danger of any potential investment being siphoned off to meet the acute care crisis,” said the RCP’s president, Professor Jane Dacre.

But Prof Dacre added that the initiatives should be given time to show more benefit, backed by greater involvement by local authorities and extra funding for social care.

NHS Providers chief executive Chris Hopson offered assurance that there has been “real progress” in integrating health and social care, but stressed that the NHS “has to be more realistic” about what savings can be delivered – including accepting that the BCF would not achieve its aims alone, as it is essentially “political cover” for a reduction in the health and care budget.

“We have called for a new plan to take the NHS through the rest of this Parliament, which addresses with absolute clarity the growing gap between what the NHS is expected to provide, and the resources available, including a realistic assessment of the pace of closer integration and what it can deliver,” Hopson concluded.

A Department of Health spokesperson said that the BCF is just one element of the government’s programme to integrate health and social care for the first time and praised the success of the Fund in encouraging local areas to collaborate to improve their services.

“We will build on this for the future in making care even more joined-up,” the spokesperson said.

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Lainey 2012   08/02/2017 at 14:16

This will come as no surprise to the people within health and social care who are trying to implement this policy. In the face of a growing elderly population, increasing technology and with the limits on growth in services both planned and unplanned (mainly through recruitment difficulties) the Government has created a car crash scenario. The elderly and their carers are victims as are the staff trying to deliver safe care in extreme circumstances. Let's hope that the CQC attributes blame accordingly when the inevitable happens.

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