Older people are being let down by fragmented care services, and the key to securing better outcomes for them – and delivering the required efficiency savings for the NHS – is joined-up services, say MPs.
“It is impossible to deliver either high-quality or efficient services when the patient is passed like a parcel from one part of the system to another, without any serious attempt to look at their needs in the round,” according to Stephen Dorrell, chair of the House of Commons Health Select Committee.
“This obvious truth has often been repeated but seldom acted upon,” he added, launching the report of a recent enquiry by the Committee into social care, which he described as the “latest in a long line of reports which have stressed the importance of joined-up services.”
“The funding for NHS care, social care and social housing comes from different sources. Apart from a few exceptions like Torbay Care Trust in Devon, attempts to join up these funds and to integrate services have been disappointing,” added Mr Dorrell, who is Conservative MP for Charnwood.
The report’s central recommendation is that “the key to joined-up services is joined-up commissioning,” say the MPs. They call on the government to place a duty on the new clinical commissioning groups (CCGs) and local councils to create a single commissioning process, with a single accounting officer, and a single outcomes framework for older people’s health, care and housing services in their area.
“This would improve outcomes by making it easier to move money around the local health, housing and social care system. It will also play a significant part in delivering the Nicholson Challenge for the NHS of 4% efficiency savings every year over the next four years,” they say.
The Committee also calls for policy to be coordinated more effectively across Whitehall, with regular rebalancing of national spending across health, housing and care services, and for a new, integrated legal framework to be developed to support integration of health, social care and other services around the needs of the individual.
The MPs’ recommendations have been welcomed by health care policy think tank The King’s Fund, which says that delivering integrated care must assume the same priority over the next decade as reducing waiting times was given over the last.
“The Committee is right to stress that a more ambitious approach is needed to achieve this based on coordinated commissioning and pooled budgets. We think this could go a stage further by moving towards a single assessment of the funding needs of the NHS and social care in future spending reviews,” said Richard Humphries, senior fellow at the Fund.
He added that the MPs’ report “hits the nail on the head by calling for health and social care services to be organised around the needs of older people and those with complex needs. In our view, this could be achieved by setting an ambitious new goal to improve the experience of patients with complex needs, backed up by enhanced patient guarantees including an entitlement to an agreed care plan and a named case manager responsible for coordinating care.”
The NHS Confederation also said that the Health Committee was “absolutely right” that the health and social care system has to be better integrated.
“The starting point must be to find a long-term solution to social care funding as, without reform, the system is on the brink of collapse,” warned Jo Webber, deputy director of policy at the Confederation.
She also agreed with the panel’s view that the Health and Social Care Bill is unlikely to genuinely encourage integration. “While promotion of integration is written into the Bill, the creation of new bodies and the division of responsibilities for various service risks fragmenting care more rather than less,” she said, adding: “this is a particularly worry for older people who tend to have more than one illness and so require integrated care from different services acres health and social care.”
