The road to integration is longer and more costly than the government thinks: Norman Lamb says health and social care will be integrated by 2018 but underestimates the investment required.
There is a great deal to welcome in the announcement from health minister Norman Lamb that there will be a big push to integrate health and social care, but the road ahead is longer, more difficult and considerably more costly than the government recognises.
The plans provide an ambition around which all care services can unite, and there is a strong commitment to identifying and overcoming the barriers, through the work of at least three waves of large-scale pioneer areas backed up by a dedicated central team. A dozen national health care organisations have pledged support in a declaration of "shared commitment". Every part of the care system will be expected to make progress.
But the government is grossly underestimating the investment required to establish integrated services. On the Today programme on Monday, Lamb claimed: "You can achieve savings pretty quickly … If you pool the resources, you can do brilliant things." But this is not backed up by the evidence.
In south London, Southwark and Lambeth Integrated Care is bringing together services for older people across two councils, two clinical commissioning groups, King's College Hospital, Guy's and St Thomas' Hospitals and South London and Maudsley Mental Health Trust. According to HSJ, they will invest £6.5m a year for the first three years, plus substantial one-off costs. They believe at that point savings will begin to outweigh costs as bed occupancy and care home use falls.
Similarly, according to the BMJ, the widely praised North West London Integrated Care Pilot for older and diabetes patients cost £5.7m to launch and has running costs of £3.5m.
These are big sums across confined areas. Savings are not achieved "pretty quickly"; net savings take a good number of years to come through, and that is assuming that projections are met.
The government claims that integration will be promoted in the health and care settlement to be announced in next month's spending review, but whatever sleight of hand is deployed in the form of nominally ring-fencing a couple of percentage points of clinical commissioning group budgets, the truth is that there is no new money, and investment will have to be funded by efficiencies or cuts.
But there are still some quick and reasonably cheap wins to be had. Ensuring that contact with social services is not broken as soon as someone is admitted to hospital would make a profound difference to the continuity of care for many older people. Ending the unforgivable practice of deciding someone should be shovelled into a care home when they are still lying in their hospital bed, rather than after recovery, would save substantial sums and enhance the quality of life for many.
At the front of the queue for barriers to be breached by the pioneers will be law, IT and sharing savings between organisations.
One barrier that is constantly thrown in the way of any conversation about integration is competition law. This is certainly going to cause problems and it is an issue which the government and Monitor need to examine, but it must not be allowed to justify inactivity. Some people seem more interested in complaining about it than overcoming it.
Similarly, the pooling of savings can be complicated but is hardly insoluble.
Integration has to extend into the rest of the community. Developing dementia-friendly local services, such as training shop and transport staff in how to support people with dementia, can keep people living in their own homes for longer and protect their feelings of self-worth and independence.
The health reforms encourage integration by bringing key partners together at health and well-being boards. As well as providing a place where strategies can be decided and data brought together, they serve as a symbol of people in different parts of the system understanding the perspective and value of others.
Understanding and culture trump everything when it comes to making integration a success. Hospital and care services can only work together effectively if each group of staff understands what the other lot do, how they work, and have some appreciation of the care options and implications. Having a shared understanding around reablement, for example, is crucial. It is with people, rather than systems, that the time and money needs to be invested. Guardian Professional.
There is a great deal to welcome in the announcement from health minister Norman Lamb that there will be a big push to integrate health and social care, but the road ahead is longer, more difficult and considerably more costly than the government recognises.
The plans provide an ambition around which all care services can unite, and there is a strong commitment to identifying and overcoming the barriers, through the work of at least three waves of large-scale pioneer areas backed up by a dedicated central team. A dozen national health care organisations have pledged support in a declaration of "shared commitment". Every part of the care system will be expected to make progress.
But the government is grossly underestimating the investment required to establish integrated services. On the Today programme on Monday, Lamb claimed: "You can achieve savings pretty quickly … If you pool the resources, you can do brilliant things." But this is not backed up by the evidence.
In south London, Southwark and Lambeth Integrated Care is bringing together services for older people across two councils, two clinical commissioning groups, King's College Hospital, Guy's and St Thomas' Hospitals and South London and Maudsley Mental Health Trust. According to HSJ, they will invest £6.5m a year for the first three years, plus substantial one-off costs. They believe at that point savings will begin to outweigh costs as bed occupancy and care home use falls.
Similarly, according to the BMJ, the widely praised North West London Integrated Care Pilot for older and diabetes patients cost £5.7m to launch and has running costs of £3.5m.
These are big sums across confined areas. Savings are not achieved "pretty quickly"; net savings take a good number of years to come through, and that is assuming that projections are met.
The government claims that integration will be promoted in the health and care settlement to be announced in next month's spending review, but whatever sleight of hand is deployed in the form of nominally ring-fencing a couple of percentage points of clinical commissioning group budgets, the truth is that there is no new money, and investment will have to be funded by efficiencies or cuts.
But there are still some quick and reasonably cheap wins to be had. Ensuring that contact with social services is not broken as soon as someone is admitted to hospital would make a profound difference to the continuity of care for many older people. Ending the unforgivable practice of deciding someone should be shovelled into a care home when they are still lying in their hospital bed, rather than after recovery, would save substantial sums and enhance the quality of life for many.
At the front of the queue for barriers to be breached by the pioneers will be law, IT and sharing savings between organisations.
One barrier that is constantly thrown in the way of any conversation about integration is competition law. This is certainly going to cause problems and it is an issue which the government and Monitor need to examine, but it must not be allowed to justify inactivity. Some people seem more interested in complaining about it than overcoming it.
Similarly, the pooling of savings can be complicated but is hardly insoluble.
Integration has to extend into the rest of the community. Developing dementia-friendly local services, such as training shop and transport staff in how to support people with dementia, can keep people living in their own homes for longer and protect their feelings of self-worth and independence.
The health reforms encourage integration by bringing key partners together at health and well-being boards. As well as providing a place where strategies can be decided and data brought together, they serve as a symbol of people in different parts of the system understanding the perspective and value of others.
Understanding and culture trump everything when it comes to making integration a success. Hospital and care services can only work together effectively if each group of staff understands what the other lot do, how they work, and have some appreciation of the care options and implications. Having a shared understanding around reablement, for example, is crucial. It is with people, rather than systems, that the time and money needs to be invested. Guardian Professional.
No comments:
Post a Comment