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“Lack of progress towards integration disappointing but not surprising”

Chris Ham, Chief Executive of The King’s Fund

“We agree with the NAO report that place based planning and health and social care integration are the right ambitions for the NHS and local government to pursue.

“If these ambitions are to be realised, barriers to integration such as misaligned financial incentives and different planning cycles must be removed. Sufficient time must be allowed to build the relationships on which partnership working depends, and to deliver measurable improvements in care.

“These and other lessons from the NAO’s analysis need to inform work to develop new care models and sustainability and transformation plans (STPs). Failure to do so will result in well-intentioned policy initiatives falling well short of their objectives.

“At a time when greater integration of health and social care is needed more than ever, the Department of Health, the Department for Communities and Local Government, NHS England and other national bodies should respond with urgency to address the shortcomings identified by the NAO. Our forthcoming analysis of the 44 STPs in England will outline the other changes required, including earmarked funding to support new care models and to invest in the out of hospital services that hold out most hope of moderating demand for hospital care.

“The ambitious proposals included in STPs now need to be worked up into credible plans to deliver on the high expectations associated with them.”

RCP President Professor Jane Dacre

“The lack of progress identified by the NAO in implementing integration between health and social care is disappointing but not surprising.

“There are areas of good practice in front line led projects like the RCP’s Future Hospital Programme, and where local authorities and NHS organisations have worked well together, but the imperatives over financial targets have acted as a barrier to transformation. As we said in our recent report Underfunded, Underdoctored, Overstretched, the severe pressures on emergency and acute care are felt throughout hospitals who are only just coping.

“This background results in double jeopardy – not having enough staff and resources to introduce new parallel services to see if they can really work in integrating health and social care, improving patient experience and producing efficiency savings – and the danger of any potential investment being siphoned off to meet the acute care crisis.

“Clinicians are working above and beyond the call of duty to continue safe services and transform under very difficult circumstances.

“However, we should not take the slow progress so far as a signal to stop or reorganise the initiatives – it takes time to transform services and evaluate them to show benefit, so they should be allowed to continue, but with much more involvement from local authorities upfront in planning and implementation, and a funding boost for social care.

“Although financial  savings are a key part of the drive to integration, care should be delivered in the right place for the patient and patient experience must be another important measure.”

Richard Kramer, Deputy Chief Executive at Sense

“Since 2012, spending on the NHS has increased 11%, while expenditure on social care by councils has decreased 10%. Cutting social care means that more demand is placed on the NHS, and it is patients, and older and disabled people that suffer.

“The situation unfortunately looks set to get worse, with our social care system chronically underfunded, the deficit predicted to grow to at least £2 billion by 2020, unless action is taken.

“The consequences of doing nothing are clear; without long-term integrated planning and significant new funding into social care; more and more people will be left without the essential services that they need to live independently and in their communities.”

 

Dr Mark Porter, BMA chair of council

“Improved integration between health and social care services would help patients move from hospital to social care settings more easily, but there is a question mark over the cost savings which can be achieved through integration. The reality is that any potential savings are unlikely  to manifest for many years, if at all.

“Integrating services should not increase pressure on an already overstretched NHS and it is crucial that health spend should not be diverted to cover shortfalls in other areas. What matters to patients and their families are not high-level structures but that they and their loved ones receive the best, joined up, care.

“The current pressure on health and social care is a direct result of years of inadequate funding and politicians of all parties failing to take a long-term view on what needs to happen. Now is the time to put politics to one side and reach a cross-party consensus on how to tackle this crisis by finding services to meet the need that we know patients have.”

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