The Government have recently issued a new White Paper ‘Health and social care integration: joining up care for people, places and populations’. The aim of the paper is to eliminate the ‘complex and disjointed systems’ currently in place and offer a more person centred joined up straight forward experience.
This White Paper is part of a wider set of mutually reinforcing reforms, and builds on the Adult Social Care Reform white paper, People at the Heart of Care, the Health and Care Bill and reforms to the public health system. It sets out our plans to make integrated health and social care a reality for everyone across England and to level up access, experience and outcomes, ensuring everyone gets the treatment and care they need, when and where they need it.
How did we get here?
The Government has recognised there is often a lack of coordination between the range of services providing health and social care without taking into account the holistic needs of a person.
This leads to duplication of information with a patient being asked for the same information multiple times, by different organisations leading to delays.
Delays in people being discharged as a result of competing budgets and care processes.
While progress has been made, the system remains fragmented and too often fails to deliver joined up services that meet people’s needs.
Proposals announced in the White Paper
• In the future there should be better NHS support to care homes. The integration between hospitals and social care would mean more specialist support so care home residents can be treated at the care home and avoid having to go to hospital. • Introduces an expectation for a single person, of accountable at place level, across health and social care, accountable for delivering shared outcomes. • Reinforces the role of robust regulatory mechanisms to support the delivery of integrated care at place level. • Digital tools that will empower people to look after their health and take greater control of their own care, offering flexibility and support - through the NHS App and NHS.uk, remote monitoring and digital health apps.
Reaction to the White Paper
The Independent Care Group (ICG) welcomed its promises of greater joined up working between NHS and social care services, but wants to see a "merger of those services," rather than just "repeated talk" of integration.
Chair Mike Padgham said: “Whilst all the promises of better choice, more personalised care, shared communications, better service access and coordinated services all sound very laudable, I cannot help but feel we have been here before.
“I fully welcome greater integration between NHS care services and those provided in the community, commissioned by local authorities and clinical commissioning groups.
“I think if we are honest, we can see having two separate services – one for NHS healthcare and one for social care – simply doesn’t work, however much government after government has promised and tried to integrate the two.
“All that happens, in reality, is that the status quo prevails, and social care remains the poor relation – in terms of funding and status – to NHS care, which always gets the lion’s share of any money available.
“The only way we can provide a proper service is through a merger and a decision whether a combined health and social care service is managed centrally, by the government or on a local level.”
The learning disability charity Mencap has welcomed the White Paper’s but warns that once integrated, social care must be seen as an "equal partnership" with the NHS or the measures in the White Paper and the Health and Care Bill could lead to the "medicalisation of social care."
Summary
The publication of the White Paper is broadly welcomed by representatives of the social care sector. But one detects a deal of cynicism as to whether or not the proposal will be achieved. This is hardly surprising given that social care has always been treated as the poor relation.
I find it hard to argue with the premise of the Independent Care Group. We only have to look at how the new National Insurance Tax will work and the billions to be spent on catching up with delayed operations to know that until the NHS and social care are merged, social care will remain the poor relation despite the efforts of reform and integration.
Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy