Plans to make joined up health and social care the norm by 2018 have been announced by the government.

The aim is to put an end to people being “passed round the system” and “falling through the cracks” of uncoordinated care.

Better integrated care between hospital and social care staff could relieve pressure on A&E services by preventing emergency readmissions and could also help to reduce the £370 million a year cost of long waits for discharge from hospital. It should also ensure that people get the support they need with the appropriate information and notes being shared by different parts of the system, argues the government.

“Unless we change the way we work the NHS and care system is heading for a crisis,” said care and support minister Norman Lamb.

The government has set out plans for pilot areas from September to pioneer the practical approaches that are needed to achieve change as quickly as possible.

New measures of people’s experience of joined up care and support will be introduced by the end of this year to monitor whether people are feeling the benefits of the change.

The government has also published a Shared Commitment document which sets out how the national leaders of the health and care system have come together to help local areas make integration happen.

It sets out how local areas should use existing structures like Health and Wellbeing Boards to bring together local authorities, the NHS, social care providers, education, housing services, public health and others to bring about better integration of local services.

But the government has not committed any additional money to the proposals. Instead it is suggesting that clinical commissioning groups should set aside two per cent of their annual funding for non-recurrent expenditure to support innovative approaches to integrated care.

Michelle Mitchell, director general of Age UK , said that for the government’s vision for integrated care to become a reality, there needed to be good social care provision in place with sufficient funding. Since the government came to power, £710 million in real terms had been cut from social care budgets mostly through reduced local authority funding. She called for an emergency injection of funds to “shore up the current system”.

Chris Ham, chief executive of The King’s Fund, warned that feedback from their work with local health and social care leaders indicated that some aspects of current policy and regulation were acting as barriers to delivering co-ordinated care. “This should be addressed by giving pioneer areas freedoms and flexibilities to overcome these restrictions when they are rolled out from September,” he said.

Nuffield Trust chief executive Dr Jennifer Dixon also cautioned that it would be important to learn carefully from new initiatives and not over claim their benefits. “There have been attempts to develop integrated care for at least 20 years, but with mixed results. The will is there but the policy context can often work against hard won efforts. Today’s announcement recognises this by attempting to align a number of policies to speed progress,” she said.

Professor Andrew Kerslake, associate director of the Institute of Public Care, said: “Health and social services can be integrated managerially but the important question is are services integrated at the point of delivery – in other words does the person in the community experience an integrated service that could prevent them from being admitted to hospital?

“People want to experience integrated care because they don’t want to be constantly referred from one service to another and that’s something the government is hoping to achieve but integrated care on its own won’t deliver what NHS and social care needs which is a reduction in demand.

“Also I worry that integration actually hides issues around performance because studies by the Royal College of Physicians have shown that the health service is simply not performing well enough on some of the areas concerning older people such as dementia, falls, strokes, continence etc. Integration will help but it is not necessarily the solution.”

Professor Andrew Kerslake is speaking at www.healthpluscare.co.uk on 12 June. Visit the website to register for a free ticket.

Labour leader Ed Miliband has called for the swift integration of health and care services so that the NHS can be made financially sustainable.

He cited figures from the Nuffield Trust which show, unless we improve the way services are delivered, growing care needs will leave a shortfall of up to £29 billion a year by 2020 in NHS funding. And claimed that there’s growing evidence that the coalition government’s reform programme is stifling the real change the health service needs and threatening its sustainability.

Miliband announced the launch of an Independent Commission which is being asked to find ways of integrating health and social care so that both of these key public services are affordable in an era when there is less money around than there was in the past.

Ed Miliband said: “The NHS is facing the biggest challenge in its history. The toughest financial pressures for 50 years are colliding with our rising need for care as society gets older and we see more people with chronic illnesses like cancer, diabetes and dementia.

“The NHS will always be a priority for expenditure under a Labour government but we must make every pound we spend go further at a time when our NHS faces the risk of being overwhelmed by a crisis in funding because of care needs by the end of this decade.”

He said that even in tough times there should be an expectation to provide a better service for patients. “The changes we propose will ensure that - but they do something else too. They will save billions of pounds which can be better spent elsewhere in the NHS. These reforms are necessary if we are going to ensure that the high quality effective NHS, which the British people expect, is affordable in the decades to come,” he added.

He described how the growing number of older people and those with chronic illnesses is fundamentally challenging current models of care, where different problems are handled separately in different services. Instead, he argued that the future demands ‘whole-person care’ – an agenda that would bring together physical health, mental health and social care into a single service to meet all of a person’s care needs.

By ensuring the commissioning of health and care services at local level are joined up better, both services can be planned more effectively and affordably.

He said: “In the 21st Century, the challenge is to organise services around the needs of patients, rather than patients around the needs of services. That means teams of doctors, nurses, social workers and therapists all working together. It means care being arranged by a single person who you know – ending the frustration of families being passed around between different organisations and having to repeat the same information over and over again. It means a greater focus on preventing people getting ill and more care being provided directly in people’s homes so they avoid unnecessary hospital visits.”

Labour’s Independent Commission on Whole-Person Care will be led by former Department of Health specialist Sir John Oldham. The Commission will produce recommendations on achieving Labour’s vision of ‘whole-person care’, without another top-down reorganisation and within existing resources.

Sir John Oldham commented: “I am very pleased to undertake this important task. 70% of activity and cost in the care system is for people with multiple chronic diseases, which includes a rising number of older people. Their care crosses organisational boundaries, and is fragmented. Those patients say: I want you to treat the whole of me, and act as one team, which also leads to better outcomes and greater efficiency for the whole system. We need to bring that about.

“If we don’t change, the crisis of need approaching rapidly will make the NHS and care system unsustainable, and reduce the competitiveness of our economy driving a spiral of decline. It is that significant.”

Attend a definitive event on the latest thinking and practice in Integrated Care.

An increasing focus on integrating health services by clinical commissioning groups (CCGs) could destabilise acute trusts and drive hospital reconfigurations, says a leading GP.

The integration of primary and secondary care to address the fragmentation of patient services and achieve greater efficiency and value for money means that services will be designed to more effectively prevent illness and keep patients out of hospital.

Dr Charles Alessi, chair of NHS Clinical Commissioners, says a current obstacle to integration is the payment by results system which rewards secondary care for increasing activity.

But commissioners will have to work with limited budgets and prioritise care which means that if one provider gets more money, another will get less.

“We are very conscious of the fact that we have too many acute trusts and distribution of services is not ideal so integration of health services could be one of factors that drive reconfiguration.

“The payment by results system that we currently have is a product of a different age when we were expanding the NHS. In future acute trusts will need to understand that they live within the local health economy. Integrated care is based on the premise that we need to use the resource that we have for health care as efficiently as possible. Let’s sit down and have a discussion about how we are going to do that clinically,” said Alessi.

There were likely to be heated discussions in CCG meetings which must be held in public because people need to understand the need for prioritising care.

“Integration is going to have to be driven by all sides. It’s in everybody’s interest that we get commissioning input into the process from our colleagues in secondary care. We know there is going to be a whole series of reconfigurations over the next three to four years because of the financial situation we are in. Integrating services gives us the potential to think differently around the way we deliver services,” said Alessi.

Dr Alessi will be speaking at Health+Care Conference (June 12& 13 at London’s Excel) on the potential for integrating primary and secondary care health services.

Integrating care is high on the agenda following the Labour Party’s move last week to place it centrally within their new health policy.

Emergency admissions have been reduced and money has been saved by introducing a more collaborative and proactive approach to managing older people with urgent health and social care needs in Greenwich.

This integration project between Greenwich Community Health Services, Oxleas NHS Foundation Trust and Royal Borough of Greenwich, Social Care began three years ago.

The objectives were to create a more accessible, responsive and flexible service, enabling fair access to services via a single point of entry and seamless, well-coordinated and holistic health and social care at the right place at the right time, explained Jane Wells, Service Director, Oxleas Foundation Trust in a talk in the Innovation stream of the Hospital Directions conference.

Three community assessment and rehabilitation teams consisting of therapists, social workers and nurses were set up around the borough. A joint emergency team with the same mix of staff was established to deal with all emergencies both in health and social care and an integrated hospital team of nurses and social workers dealt with discharges.

The changes have positively impacted on staff motivation to maximise quality outcomes and efficiency. The right referrals now go to the right team at the right time and the shared outcomes have enabled an increased number of people to live at home, with a reduction in emergency hospital admissions, and long-term care placements. It has also reduced the size or need for social care packages.

Wells said a crucial factor in the success of the project was to ensure that they engaged staff and trust boards in the shared values, beliefs and culture change: “Before we started designing a new way of working we were very conscious about the organisational development and cultural changes that we wanted to foster in our workforce that we were bringing together so we worked with them to get all their fears and anxieties on the table early on. We didn’t want to create a new model or way of working that was only paying lip service to integration.”

She said they will now be looking for wider integration across the entire health and social care system, bringing in GPs and links to long term conditions teams and occupational therapists.

The concept is to have a totally integrated model so that people will be able to travel through different systems in a smooth pathway and will receive the services they need said Jay Stickland, assistant director of Greenwich Social Services.

Greater integration of health and social care services has led to improved care processes, more satisfied staff and reduced use of hospitals.

These are the key findings of a two-year study, commissioned by the Department of Health, analysing 16 sites across England which formed the Integrated Care Pilot programme. The sites piloted different ways of integrating care, such as between general practices, community nurses, hospitals and social services.

The research carried out by Ernst & Young, RAND Europe and the University of Cambridge considered the impact of better integrated care on elderly people at risk of emergency hospital admissions and the treatment of conditions including dementia and mental health problems. It analysed staff and patient views on the work of the pilots as well as the impact on hospital admissions and lengths of stay in hospital.

It showed that, if tailored to local circumstances, well-led and managed integration can improve the quality of care. Overall, 54% of staff thought patient care had improved as a result of the pilot.

The study revealed that hospital care was needed less for patients of those pilots that focused on the introduction of intensive case management which involved the identification of elderly people at risk of hospital admission and then the coordination of care by a case manager. For those patients, outpatient visits fell by 22% and planned admissions by 21%. Consequently, savings of 9% were made in the overall costs of hospital care.

The pilot locations also saw increases of 8% in patients receiving care plans and a 9% rise in those knowing who to contact with questions after hospital discharge.

However, there was a drop in the proportion of patients and service users who felt involved in their care over the course of the pilots, and significant numbers who felt their preferences were taken into account.

Martin Roland, Professor of Health Services Research at the University of Cambridge and co-leader of the research, said: “Improvement in care processes is certainly a key benefit of integrated care, but we cannot afford to lose sight of the patient who may have a different perspective on the services they receive, such as the importance of having continuity of care from doctors and nurses.

“We have also seen how difficult it is to reduce emergency admissions for vulnerable elderly people even when everything appears to be set up to manage demand for hospital admission. This is not the first study with such findings suggesting that there may be genuine unmet need among this group of patients and that services should be planned taking this into account. However, the study also shows the potential to move other types of care from hospital into the community, for example reducing the need for outpatient attendance.”

Six out of ten staff thought they worked more closely with other team members and 72% reported better communication with other organisations.  Furthermore, 84% staff said their job had expanded, with 64% saying their role had become more interesting.

Dr Richard Lewis, Partner at Ernst & Young, and co-leader of the research, says: “These evaluation results provide grounds for optimism that integrated care will deliver at least some of the hoped for benefits. The issue of poor care integration has long been highlighted as a key faultline in the NHS and the wider care system so these findings are significant.

“However, this optimism must be cautious at this stage. Change takes time and, it may still be too early to provide a complete picture of the outcomes of integrated care.”

“The professional staff involved in the pilots clearly believed that integrated care allowed  them to practise in a more effective way. However, the reaction of patients to integrated care is surprising. While some essential processes such as care planning have become more common, important aspects of the patient experience appear to have diminished. It may be that staff within the pilots have concentrated on improving their professional care but, in the process, lost focus on the individual patients at the centre of that care.”

The two-year evaluation was designed to understand what whether integrated care offers benefits for patients, staff and the wider NHS. It drew on a number of different evaluation methods: ‘before and after’ staff and patient questionnaires, analysis of hospital activity data and costs compared to matched controls, interviews with patients and staff, a regular journal.

Despite variations across the pilots, they broadly shared a number of similar aims: bringing care closer to the service user, creating teams that crossed organisational boundaries, providing greater continuity of care, providing more preventive care and avoiding unnecessary hospital care. In particular, a subset of six pilots focused on intensive case management of elderly people at risk of emergency hospital admission. Most of the pilots concentrated on integrating community based services (such as general practice, community nursing and social services) and far fewer on ‘vertical’ integration between primary and secondary care.

The NHS Future Forum was tasked with reporting on integration as one of four themes relating to driving improvements and achieving higher quality of care and their report was published on 10 January.