Health and social care integration ‘must not be an aim in itself’
The ‘why’ and ‘how to’ behind integration, and how it can be used to achieve better outcomes and reduce costs, by Sarah Pickup
Among the plethora of legislation, guidance, visions, strategies and plans that are current in the NHS and local government at the moment the concept of “integration” is commonplace. It is accepted to be a “good thing” yet often that is as far as it goes – there is little detail about what should be integrated and why, never mind how.
Integration must not be an aim in itself, it should be something we consider if we believe that by working more with others we will get better outcomes for those we are there to serve; improved or faster access or reduced costs to deliver outcomes that are at least as good.
In the world of health and social care there are a number of different areas of work where integration could be considered: commissioning of services, access to services, assessment of need and delivery of services. Each of these will have different potential partners. Integrated commissioning is often a partnership between health commissioners and local authorities. Integrated access and assessment may well involve acute and community trusts, local authorities and GPs. Integrated delivery of services could involve the joining of acute and community services in one trust, the creation of multidisciplinary teams between community health providers and councils, or could require alignment of independent or voluntary sector delivered social care services with the NHS providing nursing and therapy services. Integration can mean anything from full TUPE transfer of staff to joint management arrangements, or from agreements to align services to enabling one organisation to directly access services commissioned by another.
It is clear that in the current climate we cannot afford to duplicate effort or run parallel systems and that it is a false economy to wait until people’s needs are at their greatest before offering support. Both in health and social care the majority of our resources will always be spent on those with the highest needs and we must ensure that these people receive high quality, personalised care and support. However, we will not be able to afford this if we do not do everything we can to reduce the numbers in this high needs group.
GPs, community health services, public health and social care services need to work together to ensure that we prevent needs arising where that is possible, for example, identifying people at high risk of acquiring a long-term condition and helping them with information, advice and low-level support. Then, where people do have an episode of higher needs, offering services that focus on reablement, recovery and rehabilitation. It is in this area of prevention and recovery that there is probably the most untapped potential to achieve better outcomes and reduce costs by integration of activity. For example, proper treatment of incontinence and effective action following a stroke can significantly improve people’s quality of life and reduce the need for care home admissions and consequent costs to local government. On the other hand, rapid response home care services and accessible short stay places can prevent hospital admissions, and the provision of equipment and advice in the home can prevent falls and the consequent costs to the health system.
With a health and social care act that establishes clinical commissioning groups (CCGs) and health and wellbeing boards and moves public health into local government, as well as the forthcoming white paper and draft bill on adult social care, there is a real opportunity for central government to ensure that the incentives in the system really drive integration where this makes sense and for local government and CCGs to seize the opportunity to improve outcomes and reduce costs in their local area.
Sarah Pickup is president of the Association of Directors of Adult Social Services (ADASS) and will be speaking about integration at NHS Confederation conference
