All disabled and older people would enjoy integrated care by 2018 under plans to overcome the health and social care divide, announced today by care services minister Norman Lamb.
Lamb said he wanted to bring to an end service users’ experience of multiple assessments, poor information sharing and disconnected services, while significantly cutting delayed discharges from and emergency readmissions to hospital. While the government will not stipulate how services should integrate, Lamb has vowed to remove legal and practical barriers to integration identified by a set of “pioneer” areas, who will be selected later this year to test how co-ordinated care can be achieved most quickly.
Overhaul of payment by results
This is likely to lead to an overhaul of payment by results, the system under which NHS commissioners pay hospitals on the basis of volumes of treatments, which has been criticised for sucking resources into the acute sector that would be better spent on integrated care in the community.
Yesterday, healthcare regulator Monitor and NHS England launched a review of the NHS payment system, which will look at how systems for paying providers can drive integration across health and social care.
Lamb said the government’s goals were improving service users’ experience of care and getting much better value for money from health and social care. “Too often we waste resources on duplicated effort without joining up care in the patient’s interest,” he told Community Care. “Too often organisations focus on their financial position, not the needs of the patient.”
He said the pioneers would be encouraged to “push the boundaries of what’s possible” in integrating care, adding: “We want to work with the pioneers to see what the barriers are and remove them.”
Backing from health and social care leaders
The government’s programme has been backed by health and social care leaders through a “shared commitment” to deliver integration, whose signatories include the Association of Directors of Adult Social Services, Local Government Association, Monitor and NHS England, as well as the Department of Health. They will jointly fund an “integrated care and support exchange team”, who will support and advice the pioneers and other areas on overcoming barriers to integration.
The government will also develop new indicators of progress on co-ordinating care and support, based on service user’s experiences, by the end of the year, to gauge progress on integration. This is complemented by a “narrative” published today by health and social care charities’ umbrella group National Voices, setting out what good integrated care looks like for service users.
Lamb stressed that there would be no “central blueprint” for integrated care, adding: “What we are saying is that providing joined-up care for patient is vital to delivering good are but it is for local areas to design how they want to achieve that.”
Failures in integrated care
There have been several reports of failures in integrated care in recent months:
- In March, Alzheimer’s Society warned that the NHS was not commissioning adequate health services for care home residents with dementia, after the Care Quality Commission revealed that residents with dementia were admitted to hospital significantly more than those without the condition in half of NHS areas;
- Social work leaders have expressed significant concerns about the impact on patient care of moves by councils to pull social workers out of integrated mental health teams;
- Last year, consultancyiMPOWER warned that GPs were encouraging people to enter residential care prematurely because of “dysfunctional relationships” with social workers.
Concerns have also been raised about the impact of the changes to NHS structures brought in on 1 April on joint working, despite the underpinning legislation, the Health and Social Care Act 2012, including measures to promote integration.