The majority of local authority chief executives and council leaders don’t believe integrating health and social care will generate cost savings for their local authorities, according to a report by consultancy firm PWC.
The report, based on a survey of 125 UK council leaders and chief executives, found that 85% of bosses agreed that integration would improve care outcomes but only a third (32%) felt it would generate savings for their local authority.
When asked about barriers to integrated care, respondents highlighted a conflict in culture between local authorities and NHS providers and commissioners, funding pressures and misaligned incentives.
“The main barrier to integrated care is that our neighbouring local authorities ‘do not get it’. Some organisations do not get the bigger picture in fear that they may not exist as a result,” said one chief executive.
Another said: “Many in the health service believe they will be bailed out financially and so don’t fully embrace the need for change.”
Respondents were split on their views of the Better Care Fund, the £3.8bn pooled budget between adult social care and NHS that is due to start in April 2015. Asked if the fund had positively impacted their ability to deliver better public services, 30% agreed, 30% disagreed and 40% were neutral. Respondents said the “short timescale” was the biggest challenge to making the fund work, the PwC report said.
The report, PWC’s fourth annual survey of local authorities, also found that eight out of 10 councils leaders believed some councils would fail to deliver essential services within the next five years. Nine out of 10 thought some local authorities would run into serious financial problems over the same period.
The research also surveyed 2,000 members of the public. Just 35% accepted the need to reduce or close services in their area, a drop of 10 percentage points from 2011.
Graeme McDonald, director of local authority chief executives group Solace, said: “Understandably the public are now very concerned about the impact of these cuts on their community and their own lives, as reflected by acceptance reducing for these changes.
“Integration is key for the future of local public services as budgets continue to be reduced. It drives efficiency, but more importantly enables early intervention and prevention.”
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If saving can be made it is a bonus but surely the biggest priority in getting rid of that gap is to get those in need the best service possible. Another comment that shows the biggest error in Social Care is that it is service lead and not user lead (Person Centred) as it should be.
It is not in anyway contradictory to believe that better outcomes for services users will not match with savings to LAs. In most cases transfers from hospital to social care or nursing home care means increased LA (or personal) costs even where the net actual overall cost reduces.
The real block to integrated care is the difference in funding regimes between NHS care that is centrally funded by taxpayers and social care that is locally funded and means-testable. The care bill entrances this difference and there is no indication that government (of any colour) intends to do anything to resolve this fundamental anomoly. While it is unresolved, it is disingenuous to blame managers for giving priority to balancing the budgets for which they are accountable.
The concern has to be that NHS managers will see this as another opportunity to cost shunt to patients and local authorities. We already see thousands of people denied Continuing Healthcare funding (unless they take their appeals to the Ombudsman or the courts), and hospitals and CCGs using the accusation of bed-blocking to pressurise local authorities into providing health care for people leaving hospital.
Integration is fine and may provide some modest savings – it will not be a panacea.