Integration: the future of health and social care?

26 June 2013

According to George Osborne, "It's a failure that costs billions." 

And for many families up and down the country, the cost of failure is personal as their elderly relatives, shunted between hospital and the care of the local authority, don't receive the help they need, when they need it. That people are "falling between the cracks" of the health and social care systems is accepted by politicians of all parties. And as the UK's population ages, it is becoming an ever more urgent concern for voters.

In his Spending Review statement this week, the Chancellor promised that integrating health and social care would be "no longer a vague aspiration but concrete reality". Or, as his colleague the Health Secretary observed, the Government "has put its money where its mouth is". Specifically, the Government has said that in 2015-16 it will allocate £3.8 billion of the NHS budget to "services that are commissioned jointly" - that is by the NHS and local authorities, which are responsible for providing social care.

The NHS is already subsidising the social care system: in its 2010 Spending Review, the Coalition said that between 2011 and 2015 the NHS would spend £3.8 billion on social care. 

This built on long-standing support for integrating our health and social services, which is regarded by many as something of a panacea: an opportunity to improve quality of care and a way of saving money.

The idea is that spending a relatively small amount on social care 'prevention' - for example, making sure someone receives the help they need around the house - means that there will be less need for costly 'interventions' - such as a lengthy spell in hospital - months or years down the line. 

In theory, your elderly father is less likely to be admitted to A&E after falling down the stairs if he's had a handrail installed. According to the NHS Future Forum, the NHS spends £600 million a year treating people whose injuries are a result of them living in a "hazardous" home, with "the vast majority" of accidents a result of falls.

Take care of prevention, and hospitals will look after themselves

George Osborne insists that the £3 billion for integrated care "will help relieve pressures on Accident and Emergency". 

Both the media and the Labour Party have recently accused the Government of presiding over a crisis in A&E. And there seems to be broad agreement across the political spectrum that the lack of social care for our ageing population is one of the main causes of the increase in emergency admissions (see the graph below). Today's Daily Mail told of elderly patients being "dumped" in A&E because the local authority can't arrange for their care.

Source: The Kings Fund

The Government collects data on how many people are delayed in hospital because they can't be cared for at home or in the community. In fact, since 2003 there's been a system of incentives in place whereby a local authority is fined if it fails to organise social care for a patient who's ready to be discharged from hospital. 

However, the Chancellor seems keen to claim credit for the Coalition. He suggests that the Government's recent investment in integrated care meant that last year "50,000 fewer bed days were lost to the NHS". In 2011/12 there were almost 439,000 "delayed days" in NHS hospitals - a day when a patient occupies a bed unneccessarily because adequate social care isn't available. The following year (2012/13) there were close to 386,000 delayed bed days, some 53,000 fewer. 

In his statement the Chancellor also argues that investment in integration "will save the NHS at least £1 billion pounds". We're still waiting for the Treasury to explain how it has calculated this figure. 

The idea of 'integration' - combining the NHS and social care budgets - could well be a vote-winner at the next election. But whether the Government reallocating £3.8 billion of the NHS budget amounts to a "huge and historic commitment of resources to social care" is open to question. Since the NHS is expected to make £20 billion of efficiency savings by 2015, it might instead be more appropriate to refer to the "huge and historic" challenge that our health and social care systems face.  

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