On Tuesday 26 February, PA and the NLGN brought together over 60 professionals from across local government, the health sector, voluntary sector stakeholders, and private sector providers to discuss the scale of the health and social care integration challenge.
A number of participants raised broad questions about the future of health and social care services and about the drivers of partnerships. These included:
- There is tension between the national health service and local social care services. Does integration require a move to a national care service?
- Are partnerships really the answer and is integration really worth the effort? Should we focus on tactical short term wins not big formal partnerships?
- Would councils be pursuing partnerships if money was not such an issue ? Can partnerships really save money anyway? Will partnerships lead to fewer organisations, so will providers/buildings have to disappear and will the public/politicians accept this?
- Will the NHS reforms help or hinder integration? What role will CCGs play? How will Health and Wellbeing Boards influence service provision?
Main themes of the discussion
Why is partnership and integration difficult?
Jim Graham,(CEO Warwickshire County Council) described partnership working between the NHS and social care as like two tectonic plates bumping into each other that made it very difficult to deliver sustained integration. This was then made harder because central government was “entirely silo driven.”
Further problems arise because of the NHS command and control approach and this makes partnership more difficult because nobody can make a decision. Paul Blantern (Northamptonshire CEO), “the culture of the NHS is very disempowered and that is the biggest challenge to fast change.”
Ian Winter (Department of Health) argued that “if we were good at partnership Baby P would not have died.” He gave the example of the Government’s re-ablement money which was meant to kick start integration but instead led to major disputes that pulled organisations apart over small amounts of money.
He also showed how even when partnerships seem to be working they may not be doing so at a deeper level. He highlighted a visit to an integrated service where staff still referred to the “NHS tea bags and social care tea bags” and underlining how thinking about separate organisations remained.
Chris Brophy (Capsticks) highlighted how everyone needed to be transparent, to deal with a lack of trust and not worry about “getting too formal too quickly.” Ian Winter felt that while being open was important there was a risk in making it clear who would be the winners and losers in any integration.
Chris Bull (ex CEO Herefordshire CC) underlined that “integration too often becomes the objective yet, of itself, it has no purpose it is just a process.”
Sean McLaughlin (Islington) felt that good integration is in place and there are times when a patient will not be able to tell whether they are being dealt with by a council service or NHS. He felt while there are worries about cost shunting, integration is not necessarily a win-lose situation. However, in all this there needs to be an understanding the politics can make local councils difficult partners and that partnership can add complexity.
Jim Graham(Warwickshire CEO) felt that effective partnership means “we have to be willing to kill off our own organisations.”
Why integration is necessary
Many participants felt that, despite the difficulties, integration was essential and inevitable. “Integration is the only future that is sensible” (Jim Graham)
Chris Brophy (Capsticks) felt that a quote from the Financial Times about global politics could equally apply here “our mutual interest in staying afloat is more important than the size of our individual cabins.”
Chris Bull (ex Herefordshire) felt integration is needed because the “social care system is buckling,” and that it needed to be about more than just organisational change but to really drive improvements in quality.
Sean McLaughlin(Islington) said over half of the identified social care savings in Islington depend on integration “it will be necessary to work in an integrated way to make the kind of savings we have to make.”
Partnerships have to go beyond just the NHS
Jim Graham (Warwickshire) highlighted the need for local government to develop alliances with primary care and to look at informal working with CCGs as they take on their new roles. Ian Winter (DoH), and a number of others, highlighted the critical need to understand that partnerships are not just between NHS and local government but need to involve much broader range of people, especially individual users and carers.
How to get support for integration
Sean McLaughlin (Islington) said that partners need to accept that there may be political opposition to integration and smarter consultation was needed but “Whatever method you use you have to be open and honest.”
Jim Graham underlined that for integration to work, money will have to be released from the acute sector and that means politicians will need to support hospital closures. “The future has to be about services and not about buildings.” This was reinforced by Niall Bolger (CEO Sutton) who said we needed to “move away from the idea that assets are the basis for services.”
Niall Bolger (CEO LB Sutton) felt that there could be a clash of cultures between the NHS and local government and a lack of understanding in the NHS of the importance of political and community engagement. Another problem was the length of time it takes to get projects in place, giving the example of the closure of Orchard Hill NHS facility which took six years to achieve.
To view the sessions in full, please click on the links below.
Session one: - anticipating the organisational, impacts of health and social care integration
Session two: public engagement
Session three: partnerships
Session four: mitigating the effect of partners moving at diferent speeds on the same project
Closing session: Balancing outcomes