"In the medium term, all parties would do well to view the local health and social care economy as an ecosystem."
steve carefull, pa social care expert
The country faces a major challenge. The combination of 45 per cent cuts in local authority funding and unprecedented growth in numbers of older people requiring complex care means significant change in service delivery is a necessity.
At a recent conference hosted by PA Consulting Group to discuss lessons from health and social care integration, senior leaders from local government, the NHS and the independent care sector shared the highs and lows of their experience.
The headlines? Integration must be part of the solution; it can increase efficiency and transform the user experience, creating a seamless service built around care outcomes, not organisational silos. However, examples of sustainable integration are hard to find. Reasons for slow progress include:
Poor relationships between local health and social care partners, with leaders often focused on defending their own organisation’s role;
The challenge of looking beyond current services – even where these are failing – and engaging constructively on a future vision;
The difficulty of predicting the outcome of integration – plus a fear of opening a Pandora’s box;
Structural differences between partners - a centrally controlled NHS and the democratically elected local authority;
The danger of differential organisational impacts – partners face radically different risks when services are reconfigured.
It wasn’t all doom and gloom though. Speakers provided great examples of care professionals from different organisations who had got together to redesign a service with the patient/user at its heart. In some cases, they had done this despite the systems and processes in their individual organisations. There was a consensus that when whole organisations get involved, complexity goes up, the pace slows and prospects of sustainable success diminish.
The problem this picture presents is that it will not satisfy the Government’s desire to squeeze out structural inefficiencies in health and social care. It’s been reported that the Treasury is in discussion with the Association of Directors of Adult Social Services (ADASS) to find ways to shield adult services from future cuts to local authority funding. The quid pro quo is that ADASS members must deliver tangible progress on integration. The isolated and small-scale examples that characterise the current position won’t be sufficient.
This increases the risk that a future government will decide that the best way to achieve comprehensive integration of health and social care is to create a National Care Service by re-structuring the NHS and local authority social care departments. That’s a prospect few will find appealing in the wake of the disruption caused by the latest NHS reorganisation.
What does all of this mean for providers of publicly funded care home places? In the short term, the pressure providers are under to accept zero or low percentage fee uplifts will continue. Some may find that joint commissioning teams emerge, which will increase the share of the local market purchased through one organisation and reduce the scope for differential pricing.
In the medium term, all parties would do well to view the local health and social care economy as an ecosystem. It will flourish or fail based on the quality of relationships and the willingness of organisations to work together to help square the circle of diminishing funds and increasing demand. The integrated health and social care economy will ask different questions of every partner – presenting threats and opportunities in equal measure. For care home providers it may become a matter of “act or be acted upon”.
Steve Carefull is a social care expert at PA Consulting Group