The integration of health and social care has been slower and less successful than envisaged, the National Audit Office has warned.
As a result, a report says, the government’s plan for integrated health and social care services across England by 2020 is at significant risk.
While the Better Care Fund, the principal integration initiative, has improved joint working, it has not yet achieved its potential, the report says.
The fund has not achieved the expected value for money, in terms of savings, outcomes for patients or reduced hospital activity, from the £5.3 billion spent through it in 2015-16.
Planned reductions in rates of emergency admissions were not achieved, nor did the fund achieve the planned savings of £511 million – in the face of increased demand and constrained finances.
Compared with 2014-15, emergency admissions increased by 87,000 against a planned reduction of 106,000, costing £311 million more than planned.
Furthermore, days lost to delayed transfers of care increased by 185,000, against a planned reduction of 293,000, costing £146 million more than planned.
The Fund has, however, been successful in incentivising local areas to work together; more than 90% of local areas agreed or strongly agreed that delivery of their plan had improved joint working.
Local areas also achieved improvements at the national level in reducing permanent admissions of people aged 65 and over to residential and nursing care homes, and in increasing the proportion of older people still at home 91 days after discharge from hospital into reablement or rehabilitation services.
There is general agreement across the health and social care sectors that place-based planning is the right way to manage scarce resources at a system-wide level. However, local government was not involved in the design and development of the NHS-led sustainability and transformation planning programme.
Local authorities’ engagement in the planning and decision making phase has been variable, although four sustainability and transformation planning areas are led by local authority officials.
The Department of Health and the Department for Communities and Local Government have identified barriers to integration, such as misaligned financial incentives, workforce challenges and reticence over information sharing, but are not systematically addressing them.
Research commissioned by the government in 2016 concluded that local areas are not on track to achieve the target of integrated health and social care by 2020.
The report also found that NHS England’s ambition to save £900 million through introducing seven new care models may be optimistic. The new care models are as yet unproven and their impact is still being evaluated.
According to the NAO, while the Departments and their partners have set up an array of initiatives examining different ways to transform care and create a financially sustainable care system, their governance and oversight of the initiatives is poor.
The Integration Partnership Board only receives updates on progress of the Better Care Fund with no reporting from other integration programmes.
In addition, the NAO found no compelling evidence to show that integration in England leads to sustainable financial savings or reduced acute hospital activity.
Amyas Morse, head of the National Audit Office, 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.
“So far, benefits have fallen far short of plans, despite much effort. It will be important to learn from the over-optimism of such plans when implementing the much larger NHS sustainability and transformation plans.
“The Departments do not yet have the evidence to show that they can deliver their commitment to integrated services by 2020, at the same time as meeting existing pressures on the health and social care systems.”
Dr Mark Porter, BMA chair of council, added: “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.”
“Now is the time to put politics to one side and reach a cross-party consensus on how to tackle this crisis by funding services to meet the need that we know patients have.”