An early study by the Policy Innovation Research Unit into the development of Health And Social Care Integration in England has found it struggling. Just as in Scotland, H&SCI started with ambitious visions to transform care for people with multiple long-term conditions and frail older people by shifting services out of hospitals, reducing costs and improving people’s experiences of care
There had been plans to use a wide range of initiatives to meet these objectives including multi-disciplinary teams, improved access to services, rapid response teams to reduce avoidable admissions, telecare and telehealth, increasing the use of community resilience and personal health budgets.
However such ambitions became more limited and focused on “short term, financially driven goals”, mainly around containing hospital admission and discharge costs. The range of initiatives used had narrowed to setting up multi-disciplinary teams, improving care planning, creating a single point of access for services and using care navigators to provide people with information and advice on accessing care.
Things that helped integration work were:
· Where there were simple organisational structures, such as a single council and NHS trust sharing similar boundaries.
· When staff were involved in integration initiatives to the extent that they felt ownership over them.
Things that were barriers to integration were:
· Professional boundaries and cultural differences between health and social care staff
· Failure of staff from different professions to trust one another
· Staff too busy “firefighting” to maintain existing services to be motivated to engage in integration initiatives.
· cuts to services such as befriending services, lunch clubs and peer support which undermined initiatives to develop communities’ resilience
· A lack of dedicated funding, hampering the ability to initiate changes to services.
In Scotland, we are at a very early stage. In a number of areas, Shadow Joint Boards have been meeting over the last year while in other areas the Integrated Joint Board are only now meeting for the first time.
However the government are already taking action. They will review what should be the right number of Integrated Boards. This could lead to mergers, more shared boundaries for health and social care services and perhaps as few as 3 - 8 new Boards to cover all of Scotland.
And the Scottish Government are promising a further £1.3 billion in the integrated partnerships to build up social care capacity. This would work to undercut the some of the difficult financial choices and could see more being spent on mental health, GPs and social care.
Nonetheless it would be rash to ignore the lessons emerging from England given the hopes and expectations being placed on this policy.
A QUESTION OF DEMOCRACY
At the Highland Health and Social Care Partnership meeting of 3rd of March which cut the weekly income of social care clients by £22 (see newsletter article on care charges), only one elected Councillor was present. The rest were all NHS Board members or non voting employees.
Exactly when did such decisions start being left in the hand of unelected technocrats?