Integrating health and social care is the only way to ease pressure on the NHS
Author: Alex Thomson, in the Guardian |
In 1997 Labour was talking about breaking down the Berlin Wall between health and social care. Nearly 20 years later, what’s changed? Well, not a lot in terms of systematic integration, but a very great deal in terms of government finances.
And that’s the difference. Proper integration that provides better care for many hundreds of thousands of people, as well as saving scarce resources, is fundamentally important for the future viability of both local government and health services across the country.
Which is why Guardian readers might have been surprised to read that the Better Care Fund, the first tangible whole-system move towards integration, could be delayed pending concerns about whether the planned savings could be delivered. This will have worried many in local government, who have spent months working on detailed proposals with clinicians.
Could this mean that integration of health and social care is simply unrealistic? It’s certainly true that the technical and bureaucratic hurdles to joining up the two services are truly formidable, so it should surprise no one that the fund is not proving easy to establish. However, as the Department of Health was quick to point out, the scheme doesn’t go live until April 2015 so it seems premature for commentators to be writing off the programme with nearly a year to go.
Another barrier to integration is the culture clash between the different systems. It is possible that this story is less about the fund itself, and more about the unhappiness of some vested interests within Whitehall and parts of the NHS.
The likelihood that there is more disgruntlement than disaster is strengthened by some of the references in the story to the creaking canard that local government can’t be trusted, because any cash left within range of councils will be snaffled to fill in potholes – in order to win over the “local authority vote”, whatever that is. There also seems to be a belief that an injection of £2bn would be enough to “rebuild the local government public finances”, which might raise a wry smile with some.
But all of this is a distraction from the crucial point that integration is the only viable way to release some of the extreme pressure on our healthcare system. While the Better Care Fund model is not the only vehicle for integration, if key figures in Whitehall and the health establishment cannot bring themselves to support radical reform for a more preventive, efficient system – as those across the political and professional spectrum have argued for decades – the future may be bleak indeed.
Alex Thomson is chief executive of the localism thinktank Localis.