Why integration’s the only game in town
Author: Steven Howell, in the MJ |
Launching our major new report, In Sickness and In Health, Norman Lamb MP described fully integrated health and social care as ‘the only game in town’.
And it is a game successive governments have at least tried to play ? but invariably failed to win. Until now, we hope.
It is a prize well worth winning ? a truly integrated system of care could revolutionise the way that health and social care is delivered, providing a much better service for users while at the same time having the potential to save millions.
The minister made an impassioned case for health integration, drawing particular attention to the role of local government in forging this closer engagement.
He sees the newly created Health and Wellbeing Boards as ‘potentially revolutionary in the way care is delivered.’
For Norman Lamb, ‘a lot of innovation in the past has come from local government.’ Our report finds local authorities with a renewed appetite for experimentation, fostering links and synergies with wider local government functions.
In our survey of over 80 local government leaders, 76% rated their level of preparedness to work with new local health and care providers between eight and 10 out of 10.
But, as the minister candidly accepts, the road to a fully integrated health and care system is a rocky one, and the system is still far from perfect.
Significant barriers remain ? the unsustainable financial situation for both social care and the NHS represents both a driver towards integration and an unstable element in bringing them together.
The ‘graph of doom’ scenario is well known to those in the sector, with the LGA’s predicted 16.5bn funding gap by 2020 largely down to the spiralling cost of care provision.
The Government has tried to cushion the short-term impact and encourage innovation through a 3.8bn fund to support the integration of health and social care, an increase from the 1bn transfer for 2014/15, which is a welcome step in the right direction.
However, while the consultation on a raft of reforms to the wider care and support system rumbles on, the long-term financial sustainability of social care remains a live issue ? not just for the individual, but for the state, also.
The truth is that, despite social care representing such a large chunk of an upper tier authority’s controllable budget, many question marks remain about how care will be delivered under an integrated, personalised system and how much it will cost.
Looking at more immediate issues, the frequent reports of issues with data sharing between local authorities and health partners is a major concern.
The very mention of data sharing as a source of frustration was met with a groan of agreement by a whole table of local government chiefs at a round table discussion we held with one council leader saying that ‘none of our local partners know what data they can and can’t share with us’.
And, Norman Lamb agreed with the report’s diagnosis that problems in sharing data are ‘absolutely critical’ to an integrated system of care, commenting that ‘the way the system works at the moment is a nonsense.’
To counter this pressing problem, our report recommends that the Government introduces a ‘presumption in favour’ of data sharing between local health bodies.
In other words, data should be shared unless there are good reasons not to. There needs to be pragmatic, effective challenge mechanisms in place where this does not happen.
But the data sharing issue is symptomatic of a seismic shift that the Government is attempting to foster away from what Mr Lamb describes as a ‘computer says no’ mentality to a ‘you have licence to experiment’ approach.
While there is much to commend in Mr Lamb’s open-mindedness in pursuit of this most elusive of policy goals, naysayers within local government fear that the current structures will, ultimately, deliver an incomplete integration.
In particular, they argue that lacking any real statutory clout, health and wellbeing boards are in danger of becoming well-meaning talking shops.
For this reason we urge whoever forms the next Government to review the new health system in 2015 to ensure that Health and Wellbeing Boards have real influence over commissioning, and, if their democratic voice is not being heard, consider granting local government greater ? even complete ? responsibility for health commissioning.
With shadow health minister Andy Burnham threatening to do just that in 2015, were Labour to be elected, ‘merging health with social care budgets into a single 120bn pot’ ? a tantalising prospect indeed ? the question remains, how would the system react to another change in the rules of the game?
Steven Howell is a senior policy officer at Localis, the localism and local government think-tank, which launched In Sickness and In Health earlier this month.