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NAO: No compelling evidence that health and social care integration works

The government’s plan to integrate health and social care services across England by 2020 is at “significant risk” due to progress being slower and less successful than had been hoped, the National Audit Office (NAO) has warned.

The auditor advised that the Better Care Fund, the government’s main integration initiative, has not yet achieved its desired financial and service targets despite £5.3bn having been spent through the BCF last year.

And despite planned reductions in emergency admissions and delayed transfers of care, the numbers of both actually increased in 2015-16, costing the government £457m more than had been planned.

Sir Amyas Morse, head of the NAO, 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.

“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.” 

The NAO found that while government departments have set up an array of initiatives examining ways to transform care, the models are as yet unproven and governance of these measures is poor, leading the watchdog to say that NHS England’s ambition to save £900m through seven new care models “may be optimistic”.

Most damningly, the report found “no compelling evidence” to suggest that integration will yet lead to financial savings for the NHS or reduced activity in acute hospital trusts.

Despite this, the NAO found that the BCF has been partly successful, such as in encouraging local areas to work together – 90% of these areas agreed that delivering the plan had improved collaboration between them.

Areas also managed to achieve a reduction in the number of elderly people being permanently admitted to care homes, and an increase in the proportion of people being rehabilitated at home three months after their discharge from hospital.

“It will be important to learn from the over-optimism of such plans when implementing the much larger NHS sustainability and transformation plans (STPs),” Morse added.

Communities must be at the heart of future plans

The LGA agreed with Morse’s conclusions, but did emphasise that, contrary to the NAO’s findings, its own research has shown evidence that more integrated and community-based care could save the health and care system more than £1bn each year and stop a quarter of hospital admissions.

Cllr Izzi Seccombe, chair of the LGA’s community wellbeing board, added that for STPs to be effective “councillors and communities need to be at the heart of the planning process, not consulted afterwards on pre-determined solutions”.

Any failure to engage councillors will lead to vociferous opposition,” she argued.

But she also warned that despite the expected benefits, “integration alone cannot solve the financial challenges facing health and social care”.

“Only genuinely new additional government funding for social care will give councils any chance of protecting the services caring for our elderly and disabled and ensure they can enjoy dignified, healthy and independent lives, live in their own community and stay out of hospital for longer,” Cllr Seccombe reiterated.

The Association of Directors of Adult Social Services (ADASS) were also unsurprised by the NAO’s report, agreeing that integration is “not the answer” to improving social care, but should instead be seen as a means to an end to transform services for those who need them.

“The risk of integration is that it focuses on structure, whereas the focus should be on the potential to improve outcomes,” said Margaret Willcox, president-elect of ADASS. “The NHS can only be protected if social care is protected too, and the case for a single, shared and sustainable funding settlement is overwhelming.”

Willcox added that any integration must ensure that adult social care funding is “appropriately managed” to keep people well and prevent escalation, such as by making sure that people are cared for at home and by putting extra effort into making care work an appealing career.

“We urge the focus of any integration to remain on the underlying challenges and long-term sustainability of social care, and are constantly working with the NHS to keep the care market and the NHS going despite significant wider pressures,” she concluded.

A Department of Health spokesperson said that the BCF is just one element of the government’s programme to integrate health and social care for the first time and praised the success of the Fund in encouraging local areas to collaborate to improve their services.

“We will build on this for the future in making care even more joined-up,” the spokesperson said.

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