The Myth of Intgegrated Care

Commission of inquiry says politicians have fallen for myth that integrating health and social care services is best way forward
Denis Campbell, health correspondent
The Guardian, Wednesday 19 November 2014
 

The NHS is expected to face a £30bn gap in its finances by 2020. Photograph: Graeme Robertson/Getty Images

Plans by the Westminster parties and the NHS leadership to safeguard the health service’s future constitute “magical thinking” that will not ensure its survival, a group of experts has said.
In a strongly worded critique, a commission of inquiry claims that both the coalition’s and Labour’s policies are not based on evidence and will not help the NHS to close the £30bn gap in its finances that is expected to open up by 2020.
Politicians of all parties have fallen for a myth that integrating health and social care services and moving many medical services out of hospitals represent the best way of keeping the NHS sustainable, they say.
The experts also accuse Simon Stevens, the chief executive of NHS England, of making a “heroic assumption” in pledging that the service will save £22bn a year by 2020 through extra efficiency after an overhaul of how patients receive care.
They claim that none of the three main parties’ recently announced NHS funding plans will prove sufficient and that all will leave a funding gap.
The findings constitute a stark challenge to the broad consensus about the best way to help the NHS withstand rising demand for healthcare while it also deals with an ongoing financial squeeze. They come from a year-long inquiry by the commission on hospital care for frail older people, set up by the Health Service Journal, which is widely read among senior NHS managers.
The group is chaired by Dame Julie Moore, the chief executive of University Hospitals Birmingham NHS foundation trust. The health secretary, Jeremy Hunt, has described the widely admired Moore as one of the NHS’s outstanding leaders.
Her co-authors include Prof John Appleby, chief economist of the King’s Fund health thinktank, and Prof David Oliver, a government health adviser, specialist in older people’s care and president of the British Geriatric Society.
Their report says: “There is a myth that providing more and better care for frail older people in the community, increasing integration between health and social care services and pooling health and social care budgets will lead to significant, cashable financial savings in the acute hospital sector and across health economies. The commission found no evidence that these assumptions are true.”
It urges political parties and NHS leaders to “avoid wishful thinking that improving intermediate and community care, while perhaps the right thing to do, will automatically mean we can disinvest significantly in hospitals.”
The government is pressing ahead with its Better Care Fund, which from next April will move £1.9bn from hospitals’ £40bn budget into schemes in the community intended to keep patients, especially frail older people and the 15 million patients with long-term conditions, healthier at home.
Labour plans to go further, if elected, by fully integrating health and social care services to provide “whole-person care”, with the same twin aims of better looking after patients and saving money.
But the commission decries both. “Improving community care may postpone the need for hospital care, but it will make frail older people neither invincible nor immortal; mostly, they will simply need the care later,” the report says. The available evidence is at best inconsistent or negative about integration’s potential to save money, it adds.
Moore said the already variable and sometimes poor quality of care experienced by older patients could deteriorate if the NHS did not urgently rethink its planned direction of travel.
“As much as it suits us all to have one nice neat solution to the problem of our growing, ageing population – and the current policy has certainly become the accepted wisdom on the matter – the truth is that as a catch-all answer it is simply wishful thinking. Integrated community care is a good thing and we need more of it and innovative approaches, but this can never be a substitution for hospital care.”
The Royal College of Nursing said integration “cannot be relied upon as a quick-fix to the problems facing the health service”, and existing community services had recently been reduced.
An NHS England spokeswoman said: “It is critical that we get care right, not just because an ageing population is a challenge the NHS must face but the frail older people of today are the public who have paid for the NHS throughout their lives. Their contribution, hard work and belief have sustained the NHS. They should always feel it continues to offer the best for them.”
The Department of Health defended its drive to integrate services. “Moving the NHS from a system of cure to prevention is better for patients and better value for money,” it said.

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