Councils must play a more pivotal role in health and care integration

The number of people in the UK with complex needs who require both health and social care is increasing rapidly. In the south-east of England, for example, our population of over 75-year-olds (already the largest in England) is expected to nearly double to 1.5m in the next 20 years.

Health and social care provision looks increasingly unsustainable financially and local government fears the sustainability and transformation plan (STP) process won’t solve the problem.

The present system, with health services delivered by the NHS and social care by local authorities each working separately and meeting different pressures, can lead to inefficiency, delays, duplication and gaps in care.

Real integration of health and care services holds the promise of providing seamless care, tailored to the individual’s needs and focused on outcomes rather than the workforce, organisational structures or the setting in which care is delivered. It allows patients to choose and control what care they receive, where and by whom it is provided by and places more emphasis on prevention. Integration has the potential to realise cost savings and dramatically improve the quality of care.

The challenge is bringing together all tiers of local government and the NHS. These organisations have fundamentally different structures, cultures and funding arrangements, and these create significant barriers to working together in a seamless and successful way. Partners will need to break down cultural barriers and silos to focus on their strengths to deliver the best outcomes for individuals.

STPs could offer a way forward but they are NHS dominated, so remain largely focused on “cure”. Local authorities feel opportunities are being missed for a more equal partnership that also draws on councils’ skills in delivering efficient, locally-tailored services that meet people’s needs and focus on prevention.

South East England Councils (SEEC) members have identified eight solutions to common problems that will help us move towards successful integration:

  • A common definition of integration must be established. This will need to be agreed by councils and the NHS but it must place paramount importance on the needs and preferences of the individual and provide clearly measurable goals and lines of accountability.
  • Government programmes, incentives and guidance from different departments will need to be reviewed and aligned to ensure they all steer organisations towards achieving the nationally agreed definition and goals.
  • Co-chairing of STPs and other initiatives by NHS and local authority partners is essential to ensure buy-in of all parties and to start to break down barriers.
  • Health and care services must be available outside hospitals. Local authorities should have a greater role to play in delivering place-based services. For example, by providing community health alongside public health.
  • Re-designing of jobs and qualifications is needed to focus staff on delivering seamless care and to bridge organisational differences. For example, new roles such as physician assistants could bridge the gap between nurse and doctor and also help respond to an expected shortage of GPs.
  • Quality housing is essential for people with care needs. Local plans need to reflect demand for specialist housing. Such housing should also be exempt from the government’s benefit cap and proposed reduction in social rents. This would give housing associations the security to invest in homes for people with disabilities or care needs.
  • A clear and consistent approach is required for sharing and comparing data between organisations and to measuring savings from preventative initiatives.
  • Light touch guidance is needed to ensure delivery partnerships develop in a sustainable, accountable way. This will help resolve debates about whether governance or delivery should be the early priority. Some think good practice should come first – others think governance is required to ensure accountability and a route to resolving problems.

In addition to these issues, the government will also need to recognise there are limits to the amount of cost-cutting and streamlining that can take place – the growing demand for services cannot be met from current budgets indefinitely.

As we move down the path to health and social care integration, councils must play a more pivotal role. Their local knowledge and democratic accountability make them the best agency to deliver care that – as it focuses more on individual needs – will become increasing place-based.

A greater focus on prevention will also highlight the significant role that adult social care, housing, public health, youth outreach and other council services play in preventing ill-health and reducing the need for hospital care – proving the case for increased funding in these areas.

We need to break down the barriers to closer co-operation with the NHS and use local government’s proven experience of transforming services in the face of shrinking budgets, to create a new system of person-centred health and care services that are sustainable and fit for the future.

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