Integration and joint working the right way forward
There is widespread consensus that integration and joint working is the right way forward for the health and social care system to deliver the best and most effective outcomes for people and their families.
Financial pressures and an ageing population have both increased the need for joined-up working, with local authorities reducing real-terms spending on adult social care by 5.3% between 2010-11 and 2016-17, while the number of people in England aged 85 and over rose by 28% between 2006 and 2016.
There are examples across England where integrated working has been successfully applied. But it is a long way from being in place everywhere, with a range of longstanding legal, structural and cultural barriers hindering the pace and scale at which change can happen.
There has been a lot of talk within government over how to support and accelerate the integration of health and social care. In the past 20 years alone, there have been 12 white papers, green papers and consultations, and five independent reviews and consultations.
However, the Government still lacks an effective overall strategy or plan to achieve its long-held aim to integrate these two sectors.
The renaming of a Government department is a sign of intent but with local authorities squeezed (as the Committee made clear in our report on the financial sustainability of local authorities) there is no realistic prospect of progress.
Without this, people risk not getting joined-up, co-ordinated care that they need and risk getting poorer outcomes.
Comment from Public Accounts Committee Chair Meg Hillier MP,
“The time for warm words and wishful thinking is over. If Government is serious about delivering the benefits of integrated health and social care, it must act to make it happen.
Without this action, the array of outputs over the past two decades – consultations, reviews, Government papers – will never be matched by improved outcomes for service users.
For this reason we urge Government to set out a costed 10-year plan for social care to go alongside its proposed 10-year plan for the NHS.
Social care has suffered long-term underfunding and it is unacceptable that councils, under considerable financial pressure and facing growing demand for care services, must wait until 2020 for clarity.
Government must also step up efforts to break down barriers to integration across the country.
Its departments and agencies need to work together more effectively to support the roll-out of best practice, as well as the leadership necessary to drive change at local level.
There remains a wide gap in pay and career structure between people who work in the NHS and those in social care, whose workforce suffers from low pay and low esteem.
As I have said previously, social care is skilled work that transforms people’s lives. It could and should be a source of national pride.
It is vital that the Government’s workforce plan addresses these concerns as a positive step towards achieving its aim of integrating health and social care.”