Comment

29.05.19

Integration? Get these two things right first

Dr Charlotte Augst, chief executive of National Voices, a coalition of charities that stands for people being in control of their health and care, details how the integration between health and social care can be made more easily and effectively for the future.

The NHS Long-Term Plan is the last iteration of a long-standing but elusive commitment to better integration of health and social care. It is filled with ambitions: regional integrated care systems are expected to make the NHS work hand-in-hand with local authority-funded services; new primary care networks are supposed to join teams at a local level; a place-based, population health approach is set to help understand the areas that have the greatest need.

The fact that the long-awaited social care Green Paper was left behind by the NHS planning frenzy doesn’t fill us with confidence that the top tier of government is fully sold on the need to think about both as part of the same system.

There are huge frustrations for the many people who need services from both the health and care system, such as people living with the impact of stroke, dementia, arthritis or mental ill health, or people at the end of their lives. Hollowed-out social care also impacts on people who might only be sporadic users of the NHS, such as people whose operation has been cancelled because of a shortage of beds, or people who can’t access timely emergency care because hospital wards are full.

So, against these financial and structural odds, what do we hope can be achieved by the latest push for integration as outlined in the long-term plan?

In our view, what might make a significant difference is that the plan demands a shift to a ‘new service model’ with care based close to home, and is accompanied by a comprehensive approach to Universal Personalised Care. This rightly focuses on people and how their experience of using NHS services needs to change.

It contains very welcome and substantial commitments on shared decision making, good care and support planning, and access to non-clinical support that helps people achieve their ‘self-management’ goals. These programmes will force the issue of integration up the agenda.

We believe there are two important things to get right:

Care planning: Done well, it is the true enabler of integration because services all need to end up in one plan. This will require tackling the cultural and behavioural obstacles that get in the way of good holistic decision making. It won’t work to draw up a plan that focuses on clinical care but doesn’t address someone’s needs for personal care, emotional support, or help to rebuild social connections.

Social prescribing: This brings together formal statutory services and the myriad of possible support offers based in the community and voluntary sector, joined through link worker or community connector schemes. The substantial commitment in the plan is based on the welcome realisation that people with health problems often also have non-medical needs, and that communities have a big role in helping people live as well as possible for as long as possible. What is clearly not going to work is if the NHS simply throws people and their needs over the fence into local authority or voluntary sector support – community approaches are good value, but they are not free.

Any efforts to integrate services by linking healthcare and social or community support in this way will fail if they don’t acknowledge the massive pressures local authority budgets have been placed under, and the cuts to preventive community provision those have entailed. Social prescribing can’t just be ‘referrals’, it needs a commissioning plan behind it.

At National Voices, we are working towards person-centred care: people having as much control and influence over their care as possible – as patients, carers, and members of communities. We will continue to work with NHS England, commissioners, providers, health professionals, and the voluntary and community sector to make a real difference to people’s experience of using health and care services.

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