The leader of the Royal College of Nursing has called for better co-ordination of plans to integrate health and social care in England, in the wake of a highly critical report.
The National Audit Office today warned that progress with integration of health and social care had been slower and less successful than expected in delivering benefits.
”So far the benefits have fallen far short, despite much effort”
As a result, the NAO highlighted that the government’s plan for integrated health and social care services across England by 2020 was at “significant risk”.
The NAO said the Better Care Fund, the government’s main integration tool, had improved joint working, but not achieved its potential – due to increased demand for care and constrained finances.
One of the most ambitious programmes introduced spanning the NHS and local government, the fund was a pooled £5.3bn budget to encourage the NHS and councils to work more closely together.
But the NAO found fund had failed to achieve the expected value for money, in terms of savings, outcomes for patients or reduced hospital activity.
“This aim has been buried under a slew of poorly designed integration initiatives”
Planned reductions in emergency admissions were not achieved. Compared with 2014-15, they rose by 87,000 against a planned reduction of 106,000 and costed £311m more than projected.
In addition, days lost to delayed transfers of care increased by 185,000, against a planned reduction of 293,000, costing £146m more than planned, said the NAO in its latest report – titled Health and social care integration.
The fund had, however, been successful in incentivising local areas to work together, with more than 90% of local areas agreed or strongly agreed that delivery of their plan had improved joint working.
There were also overall improvements in reducing permanent admissions of patients over 65 to residential and nursing care homes, and in increasing the proportion of older people still at home 91 days after discharge into re-ablement or rehabilitation services.
Meanwhile, the NAO criticised progress in another initiative, which involved testing out different models of integrated care, in order to identify around a dozen that could be rolled out nationally.
The so-called “vanguard” sites currently number around 50 and were selected to take a lead on the development of new care models that will act as “blueprints” for the future.
NHS workforce planning has ‘serious shortcomings’
The auditors concluded that NHS England’s ambition to save £900m through introducing seven new care models “may be optimistic”, as they were yet unproven and their impact still being evaluated.
The NAO stated that an array of initiatives examining different ways to transform care and create a financially sustainable care system had been set up, but with poor governance and oversight.
Amyas Morse, head of the NAO, said: “Integrating the health and social care sectors is a significant challenge in normal times, let alone times when both sectors are under such severe pressure.”
He said the government currently had no evidence it could deliver its commitment to integrated services by 2020, at the same time as coping with pressures on the NHS and social care systems.
“So far, benefits have fallen far short of plans, despite much effort,” he said, noting that the knowledge gained should be noted by ministers in regard to other key health policies.
“It will be important to learn from the over-optimism of such plans when implementing the much larger NHS sustainability and transformation plans,” he added.
Janet Davies, chief executive and general secretary of the RCN, called on the government to answer key questions on the future of its integration policy.
“The RCN supports integrating health and care services but, as this report identifies, this aim has been buried under a slew of poorly designed integration initiatives in England,” she said.
“The need for better co-ordination between health and care services is clear – increasing numbers of people are unable to access social care, and have no option but to fall back on the NHS,” she said.
“We would welcome the strong regional and national co-ordination proposed by the NAO, that would bring the Better Care Fund and STPs closer together,” said Ms Davies.
“But the 2020 deadline is looming. Ultimately, a decision must be made whether to extend it or provide more co-ordination, clarity, and funding,” she added.