Blog post 8 June 2017
As the nation heads to the polls today and a future government is elected, I find myself musing over what it really would be like with a single pot funding stream for the NHS and social care.
Indeed, as I’ve said often, social care really is the Cinderella sister in this partnership, but if – and it’s a huge ask – there was a proper effort to share funding, would our sector ‘go to the ball’.
Progress has stalled often; too often for me.
Integration would mean coordinated assessments on patients’ need being brought together and services commissioned with a kind of corporate agreement.
I read the other day that Governments and the NHS have been firing off integration policies since the 1970s.
In 2019 we had the announcement that £2.7bn would be transferred from the NHS to local government to promote joined-up working; in 2013 the spending review announcement of the Better Care Fund, which resulted in health and local government pooling £5.3bn to integrate services and reduce pressures on hospitals; the launch that year of the Integrated Care and Support Pioneers Programme with aims to join things up by 2018 and the Five Year Forward View in 2014.
Fascinating, isn’t it, the University of York carried out a study of 38 integration schemes and discovered no real evidence of less hospital admissions.
Le me quote something from The Guardian regarding the Better Care Fund: “The fund aimed to save £511m in its first year, by cutting demand for hospital services.
“Everybody in the NHS knows that stabilising emergency admissions would be a huge achievement, let alone cutting them, yet local Better Care Fund plans played along with the fantasy that they could deliver a rapid reversal by promising total reductions of 106,000 admissions between 2014-15 and 2015-16, saving £171m.
“Admissions went up by 87,000, costing £311m more than planned. Furthermore, delayed transfers were supposed to be cut by 293,000 days; they went up by 185,000.”
The National Audit Office throws light on not so much the infighting ‘it’s my money’ issues, but the real barriers to chance:
Misaligned financial incentives, workforce problems and poor information sharing.
Driving for togetherness is well intentioned and would ease the social care crisis. But the central fabric of the structures in which both sides work will need to change.
Duplication is a massive problem, communication breakdown is another and isolation issues are plentiful.
Could tomorrow’s new government pull it off? Judging the evidence so far, probably not on my watch.