Health and social care integration plan ‘yet to improve outcomes’

The government has failed to show how integrating health and social care services is leading to better outcomes for service users, according to a report from the National Audit Office.

The report also found there was no “compelling evidence” that integration is saving money or reducing admissions to hospital, after the Better Care Fund missed its targets in 2015-16.

It found that, compared with 2014-15, there was an increase of 87,000 emergency hospital admissions against a planned reduction of 106,000, which cost £311m more than planned. The days lost to delayed discharges from hospital also increased by 185,000 against a planned reduction of 293,000, costing an extra £146m.

The NAO said the Better Care Fund had not yet reached its “full potential” and warned that the government’s plan for full integration by 2020 was now at significant risk.

The government insists that the Better Care Fund is already delivering improvements.

‘Positive examples’

The report looked at how integration is progressing between adult social care and health and the extent to which it has benefitted people who use services.

It found that there had been positive examples of integration at a local level and the policy had been successful in encouraging local areas to work together, but said 20 years of initiatives by successive governments had not led to system-wide integrated services.

The report also highlighted the pressures on social care and health due to the rising demand for services and funding cuts, suggesting that this was hindering progress.

Amyas Morse, head of the National Audit Office, said: “Integrating the health and social care sectors is a significant challenge in normal times, let alone times when both sectors are under such severe pressure. So far, benefits have fallen far short of plans, despite much effort. It will be important to learn from the over-optimism of such plans when implementing the much larger NHS sustainability and transformation plans.

“The Departments do not yet have the evidence to show that they can deliver their commitment to integrated services by 2020, at the same time as meeting existing pressures on the health and social care systems.”

‘Pipe dream’

Meg Hillier, chair of the public accounts committee, said: “Unless the Department of Health and NHS England fully engage local government in whatever rehashed targets result from sustainability and transformation plans, then integration by 2020 is nothing but a pipe dream. Meanwhile patients, and older and vulnerable adults, suffer.”

Margaret Willcox, president elect of the Association of Directors of Adult Social Services (ADASS), said: “This report is not surprising given that integration plans are obviously severely hampered by current acute pressures in social care and the NHS.

“Integration is not the answer to improving social care, but should be seen as the means to an end to transform services to provide better coordinated care for people who need it.

“The risk of integration is that it focuses on structure whereas the focus should be on the potential to improve outcomes.”

A spokesperson for the Department of Health said: “The Better Care Fund is just one element of the government’s programme for joining up health and social care services.

“As the report recognises, it has already incentivised local areas to work together better, with nine out of 10 places saying their plans are improving services for patients. We will build on this for the future in making care even more joined-up.”