PluggedIn
Author: Alex Thomson, in the MJ |
I often hear people, myself included, casually tossing out the phrase ‘health and social care integration’ in a tone that implies “why don’t they get on and do it already”.
But the unfortunate truth is that integrating health and social care is very far from easy. History suggests that any form of public service integration has a tendency to grind to a halt at the point when money changes hands; in other words, both sectors need to up their game.
But there are complexities within the behemoth that is the NHS that make integration from the health side particularly hard.
For example, I know of one local authority whose local CCG has some serious problems, including a massive budget deficit.The council has made it clear that it is keen to help tackle these problems, at significant financial and reputational risk to itself, but so far the offer has not been accepted.
Clearly nothing will happen unless the CCG wants to let the council help- and relinquishing control in this way must be hard when for decades you could rely on any problem like this being mopped up by the NHS command and control apparatus.
But just a desire to collaborate isn’t enough; you also need the ability to make the relevant decisions to get integration going, and that means besting the fearsome NHS bureaucracy.
At a recent Localis event , one public health colleague was saying how liberated they felt by their transfer into local government where, if they had a great idea, they only had to convince two people – the Council Leader and Chief Executive – to get the green light.
By contrast, he said, getting permission to do anything out of the norm in the NHS was so time-consuming and morale-sapping that staff often gave up trying.
And even if you can get a decision made, other aspects of the NHS – in particular its fragmentation – can conspire to deliver perverse outcomes. Not only are there potentially competing interests between commissioners and providers, but between local and national arms of the NHS too.
For example, one hugely important but underreported factor in the long-term configuration of hospital provision is the legacy of local PFI deals.
And with a centralised NHS estate management function – PropCo ?making decisions about local rent levels, it is easy to see how national policy drivers can override what is best for a local area. Like I said, not easy.