Coalition outlines plans on care and integration
Elliot Bidgood, 14 May 2013
Integration continues to be a government priority, with the Care Minister Norman Lamb making an encouraging announcement today that the coalition aims to set the NHS on track towards full integration of health and social care by 2018. It is hoped that this will move patients better treated in community settings away from hospitals, prevent patients ‘falling through the cracks’ by making their care more seamless and save the health service billions of pounds at a time when it faces a fiscal crunch. The Department of Health cited evidence showing that 32% of bereaved people felt that cooperation between services needed improvement at current, that many patients noted communication difficulties between different services and that many older people had to cope with delayed discharges (which also cost the NHS £370 million a year) or frequent returns to A&E due to inadequate community care.
These plans will start with finding an agreed definition of what integrated care is, the establishment of “pioneer” integration areas by September 2013 to explore approaches and the introduction of new measurements of patient experience to see if the effects of integration are being felt. The document ‘Integrated Care: Our Shared Commitment’ sets out these plans in more detail. The organisation Think Local Act Personal, which focuses on promoting community-based social care, the Association of Directors of Adult Social Services (ADASS), the Patients Association and the Local Government Association welcomed the plans. Chief Executive of The King’s Fund Chris Ham, who has been stressing integration as the main priority for the NHS and have published evidence on best practice for it, called the announcement “an important statement of intent from the government and the organisations signed up” and recommended that the pioneer areas be given “freedoms and flexibilities” from certain problematic aspects of “current government policy and regulation” that the KF had found were inhibiting integration. However, though there are examples of positive outcomes from integration both in the UK and abroad, Pulse magazine cautioned that previous official evidence from several 2009 pilots had not shown any substantial benefit either in terms of care or costs, meaning that the new pioneer groups will have to learn from previous difficulties. Separately from the coalition government’s efforts, the Labour opposition health team is also continuing to explore integration – Andy Burnham MP and Liz Kendall MP have reportedly been consulting with the Royal College of Nurses on the matter.
Additionally, on Friday the government published the long-awaited Care Bill, which has three main features. First, it updates care and support laws and introduces a £72,000 cap on social care costs, based on last year’s Dilnot Report. Second, it writes into law some of the recommendations of February’s Francis Report – Ofsted-style hospital ratings, a new Chief Inspector of Hospitals and criminal penalties for providers who publish false information. Third, two new non-departmental bodies are created to improve education and training for health professionals. The Alzheimer’s Society welcomed the new bill, but cautioned about the high cap and the “huge financial hole in the social care system”, arguing that further action may still be needed – the Labour opposition argued something similar. The Patients Association noted that the CQC “will be able to order Monitor to put trusts into special [administration] over quality failures” under new powers outlined in the bill.
An upcoming Civitas report, After Francis: Standards & Care Quality in the NHS, will address both the current government measures on care standards and the need for integration in the NHS, among other issues currently affecting the NHS.