by Blair McPherson, a former director of community services at Lancashire Council
Why such optimism about integration? It has been promoted for the last 30 years and we still only have isolated examples of best practice.
From my experience when people from health talk about integration they mean integration of NHS services not health and social care. The whole integration case was based on removing inefficient duplication and providing a seamless service for the customer thus providing a better experience. But with the move to reduce the public sector’s involvement in providing public services this seems an outdated agenda.
What’s more, if integration means health has more say in how care services are delivered I for one would point out that health is not good at providing care. Have we forgotten what has been happening to older people on NHS wards?
An integrated inspection service for health and social care has not been a success and why should we encourage health to commission care services when the experience and skills already exist in local authority social service departments. Let’s not divert more management time to this outdated, unnecessary and disruptive goal.
Unnecessary because both the NHS and social services are about to embark on a transformation which further separates commissioners from providers and which seeks to reduce the public sector’s role in providing public services.
We can see it in the increased numbers of NHS patients treated in private hospitals. Local authorities have already trodden this path with the closure of their own care homes in favour of buying care in the cheaper private sector.
There has been integration of sorts in community health and social work services. Combined mental health teams have long led the way. But a closer examination of the way they work reveals that many are only integrated in that the teams operate from within the same building.
The characteristics of integration that you might expect to find – one manager, one budget, one computer system, one case file – are most often absent.
The extent to which inefficient duplication has been reduced is more likely to be dependent on the state of the personal relationships between line managers and the extent to which staff from the different professional backgrounds get on. What’s true of mental health is also true of learning disability teams and older people’s teams. Where duplication has been removed it is just as likely to have come about through budget cuts as from a commitment to integration.
It is possible the introduction of commissioning in the NHS could provide the opportunity to look at combined heath and social care commissioning. This might stop some of the local arguments about the long term funding of care for a small group of very dependant people on very expensive care packages.
It might also be attractive to hospitals that are currently reliant on social services to fund the care packages for patients being discharged home or to care homes. Of course if the real problem is the amount of budget available then joint or an integrated commissioning arrangement won’t solve the problem.
Demise of local authorities?
Not only is integration unnecessary it is undesirable if the price of an integrated health and care service may be the demise of local authorities. A local authority’s adult social care budget makes up almost half of the authority’s total budget if you take account of the fact that the education budget is passported direct to schools.
How viable would many local authorities be if they lost half their budget? And yes that would be a bad thing for local democracy which in turn would be a bad thing for older people, disabled people and their carers who would end up having even less say about the help and support they get.
Blair McPherson is author of books on the public sector the latest of which is Equipping Managers for an Uncertain Future published by www.russellhouse.co.uk