Health and social care integration – can it be done?

When the new Chief Executive of NHS England, Simon Stevens, made his inaugural speech in May to the NHS Confederation in Liverpool, setting out what he saw as the priorities for a reformed NHS, concerns about the future affordability of the NHS in its current guise continued to pepper the front pages. The most pressing worry is the impact of an aging population on health and social care resources – thrown into stark relief by news that the death of an elderly woman in a South Wales, apparently from unexplained injuries sustained while in hospital, is now the subject of a police investigation. A solution to the difficulty of coordinating medical and social care provided by two different entities on different charging bases is the creation of the Better Care Fund, due to be launched in 2015. The £3.8bn fund, jointly raised by the NHS and the Local Government Association (but with no additional funding from central government), is supposed to help support closer collaboration in local areas between the NHS and local authorities.
 
The impact of age
 
The average cost of providing healthcare for the retired population is £5,200 per household compared with £2,800 per household for the working population (source: ONS) and although life expectancy has increased, a commensurate improvement in health has not. According to Simon Stevens, 46% of hospital admissions are over retirement age, many of whom remain in hospital longer than needed due to a paucity of care home beds in the locality or because their own homes have not been adapted to enable to them to cope by themselves. Tales of poor care and neglect of the elderly have been reverberating around the NHS for some time now and, although, inexcusable on any level, it may well be a symptom of a system unable to cope with these demands. Hence the call for a reorganisation of the NHS so that primary, secondary and community care teams cooperate more effectively and so that a flexible approach can be developed to meet local needs.
 
The Better Care Fund
 
Originally conceived as a plan to ensure better alignment between the care provided by the NHS and that provided by social services, particularly in relation to older people, the project has got off to a rocky start. A recent Whitehall report has queried its viability by criticising its financial credibility, alleging that detailed plans for how savings are going to be made are in short supply. The original idea was that the £1.9bn contribution from the NHS would essentially pay for itself by the consequential savings made by freeing up hospital resources by moving elderly patients out of hospital either to care homes or to their own homes. However, it has been pointed out that much of the expenditure is fixed: salaries and equipment making up the bulk of costs.
 
A vision for a new improved NHS
 
Ann Clwyd has recently been called to give evidence into standards of care across Welsh hospitals in the light of her personal experience of the negligent care her husband received in hospital prior to his death, and her subsequent report into the NHS complaints system. In the course of compiling her report she received many letters from people who also had experience of the similar poor standards of care in Welsh hospitals. She believes that her experience of the “callous lack of care” afforded to her husband is not an isolated incident and that it reflects a wider malaise within the health system as whole. The improvement of the standard and delivery of care was the overarching theme in Simon Stevens’ speech; patient care and survivability were the key principles that should drive the changes. He spoke of making the NHS budget work harder by getting more bang for its buck; redesigning the core delivery of services to introduce more flexibility
 
In short
 
The Kings Fund health think tank has warned that the NHS is facing a financial crisis and considers plans like the Better Care Fund to be ill thought out and unhelpful on the basis that hospitals cannot afford to lose any of their funding. However, as NHS England’s chief executive has pointed out, raising standards of patient care is not just about money but also about attitude and culture. It is a question of highlighting areas of best practice and using it to transform those hospitals where standards need improving. All this will take time which means that medical negligence headlines will continue to grab people’s attention.
 
Jeanette Whyman is a solicitor who specialises in securing NHS compensation for people who have experienced medical negligence and poor treatment.