NHS and social care services are looking after a population which is living longer and with increasingly complex health and care needs, including multiple long-term conditions.
Services need to change
Services need to change to reflect that and to be better organised around patients. Rising demand and costs for health and care are taking place alongside an unprecedented and prolonged squeeze on resources.
There are many examples of NHS and care services coming together to deliver better care and this kind of integration has been happening at local level for some time. However, further integration of services, and the organisations planning and delivering them, is too often hampered by current legislation.
Government and national bodies have yet to explain the case for change
The Government and national bodies have yet to explain the case for change clearly and persuasively. There has also been a failure to consistently engage with local leaders in the design of service changes. Overuse of jargon and poor communication confuses both health professionals and the public alike. Changing acronyms, titles and terminology have allowed misunderstanding to fester and suspicion of the underlying purpose of reform.
Debate on NHS reform is often polarising. This has been true in the case of sustainability and transformation partnerships, STPs, and, more recently, accountable care organisations, ACOs, – forms of healthcare services that share their name with but are essentially different to models from the US.
Rather than threatening the integrity of the NHS, reforms to better join-up the organisation of services, including health and social care, present an opportunity to row back the NHS-internal market. However, the litmus test must be whether these changes (ACOs, STPs and integrated care systems) improve the care, outcomes, and experience of patients.
Potential benefits of further integration
The Committee recognises the potential benefits of further integration and calls on the Government to bring forward legislation to remove legal barriers imposed by the Health and Social Care Act 2012. Many of the necessary changes require primary legislation. To rebuild the trust that previous and repeated top-down reorganisations have eroded, the Committee recommends representatives from the health and care community – the NHS, local government, professional bodies, patient groups and the voluntary sector – lead on the development of new legislative proposals for the Government to lay before the House in draft and present to the Health and Social Care Committee for pre-legislative scrutiny.
If a decision is taken, following a careful evaluation of pilots, to extend the use of ACOs in the English NHS then the Committee recommends that these should be introduced in primary legislation as NHS bodies. The Committee does not believe that the introduction of ACOs in England threatens the founding principles of the NHS or that they are likely in practice to be private sector led, but recommend establishing these as public bodies would reassure on that point.
The Government’s announcement of a long-term funding settlement is welcome. This will be essential not only to alleviate immediate pressures on health and social care services, but to facilitate the transition to more integrated care. In particular, the Government must recognise the importance of adequate transformation and capital funding to effective service change.
Dr Sarah Wollaston MP, Chair of the Health and Social Care Committee, said:
It is the triumph of our age that more people are living longer, but as MPs we too often see our constituents, their families and their carers grapple with local services that may be poorly organised around their needs and struggling to cope with the rising demand for care.
As the NHS approaches its 70th birthday national leaders, and politicians from across the political spectrum at national and local level, must help to make the case for change to the public. Any effort to transform care will flounder and lose support unless it can demonstrate that patients and their families will benefit.