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Friday, 19 October 2018

'No realistic prospect' of plan to join up health and social care, MPs warn

Written by Jennifer Cockerell

The Government still lacks an effective overall strategy to integrate the health and social care sectors, while financial pressures on local authorities mean there is "no realistic prospect of progress", MPs have warned.

The country's ageing population has led to a widespread consensus that integration and joint working is the right way forward for the health and social care systems, the Public Accounts Committee (PAC) notes in its report.

Despite "a lot of talk within Government" over how to support and accelerate this, there is still no effective overall strategy or plan to achieve it, the report said.

It suggests that, much like the NHS 10-year plan, there should also be a costed strategy set out for social care over the same timeframe.

The financial squeeze on local authorities has led to them reducing their real-terms spending on adult social care by 5.3% between 2010-11 and 2016-17, while the number of people in England aged 85 and over rose by more than a quarter (28%) between 2006 and 2016.

This means many people are at risk of not getting the joined-up, co-ordinated care they need, the report warns.

It said while there are examples across England of when integrated working has been successfully applied "it is a long way from being in place everywhere".

This is despite 12 white papers, green papers and consultations, plus five independent reviews and consultations on the issue in the past 20 years.

It notes while the renaming of the Department of Health to the Department of Health and Social Care is a sign of intent, "there is no realistic prospect of progress".

The committee said local authorities will have to wait until the 2020 Spending Review to get clarity on future funding, and while the Government "repeatedly tells us" it has increased social care funding, this is largely through council tax increases.

The report also highlights the wide gap in pay and career structure for those who work in the NHS compared with social care and it remains "concerned" that not enough is being done to tackle this.

Meg Hillier, chairwoman of the committee, said: "The time for warm words and wishful thinking is over.

"If Government is serious about delivering the benefits of integrated health and social care, it must act to make it happen.

"Without this action, the array of outputs over the past two decades - consultations, reviews, Government papers - will never be matched by improved outcomes for service users.

"For this reason we urge Government to set out a costed 10-year plan for social care to go alongside its proposed 10-year plan for the NHS."

She added: "Social care has suffered long-term underfunding and it is unacceptable that councils, under considerable financial pressure and facing growing demand for care services, must wait until 2020 for clarity.

"Government must also step up efforts to break down barriers to integration across the country.

"Its departments and agencies need to work together more effectively to support the roll-out of best practice, as well as the leadership necessary to drive change at local level.

"There remains a wide gap in pay and career structure between people who work in the NHS and those in social care, whose workforce suffers from low pay and low esteem.

"As I have said previously, social care is skilled work that transforms people's lives. It could and should be a source of national pride.

"It is vital that the Government's workforce plan addresses these concerns as a positive step towards achieving its aim of integrating health and social care."

Cllr Ian Hudspeth, chairman of the Local Government Association's Community Wellbeing Board, said: "Councils are determined to do all they can to ensure that exceptional, joined up, person-centred care and support is delivered in their communities, but with adult social care now consuming almost 40% of council budgets and facing a shortfall in funding of £3.5 billion by 2025, the need for a long-term funding plan for adult social care has never been so urgent - the Government must either outline this in the upcoming budget, or the green paper on social care."

Glen Garrod, president of the Association of Directors of Adult Social Services, said: "Health and Social Care work best when they work together - so we support local pooling and integration of the things which can help, including budgets, IT systems, co-ordinated care within primary and community settings and a focus around the 'lived experience' of those in receipt of care.

"If we put the person we are caring for at the centre of an integrated system, built at the local level, and anchor social care with long-term, sustainable funding, we can transform not just the care experience, but our communities, too."

A spokeswoman for the Department of Health and Social Care said: "We are committed to the integration of health, social care and public services, which must work seamlessly together to deliver better quality care, including through the Better Care Fund which is helping people to live independently in their communities for longer.

"We have provided local authorities access to up to £9.6 billion in dedicated social care funding over the last three years and our green paper due later in the year will set out our plans to reform the social care system to make it sustainable for the future."

Copyright (c) Press Association Ltd. 2018, All Rights Reserved. Picture (c) Peter Byrne / PA Wire.