With health and social care finances under increasing pressure and little sign that the government can afford to pump in the additional resources which would be needed to maintain historic arrangements, the integration of health with social care – allied to devolution – has emerged as the great hope.
However, local health and social care providers don't yet have a secure basis for medium-term planning, and without that there is a danger that the promising start represented by the Better Care Fund, the Manchester and Cornwall devolution initiatives and pilots linked to the five-year forward plan for the NHS will be dissipated.
CIPFA’s newest publication is Let’s Get Together: Integrating Health and Social Care; it draws on the insights provided by over 200 professionals involved in roundtable events across the nations and regions to consider the recent thinking and emerging good practice.
The paper examines the main barriers to successful integration, and how we should go about dismantling them; where devolution fits in, and how it can be played into the health and social care agenda in the best way; and what is required for successful whole system leadership in the context of looking across all services without being inappropriately focused on organisational goals rather than whole population goals.
The key recommendations emerging are that the government should:
- move quickly to address the financial and policy framework for integration in 2016/17 and beyond
- accept that there are significant transitional costs, and that benefits may take some years to come through in full: that means local health and social care bodies must be funded to enable them to invest to save
- non-prescriptively encourage increased integration
- help devolution to work optimally as a means of progressing integration by linking it to increased local control of tax income
- equalise and free up the capital funding regimes across health and social care.
And the local health and social service authorities need to:
- aim to create wellness, not just treat illness
- develop the tools to measure preventative investments in health and social care in a persuasive way
- pay more attention to where, across the whole system, money is best spent as well as how it is best spent
- take seriously the need to set up the conditions to facilitate successful systems leadership across the whole of health and social care; that will include improve finance and its audiences’ understanding of what’s happening across time and across the whole health and social care system.
The central and local focus should be on front-line experience and the agreed benefits, as these should outlast organisational fashions and restructures. The Better Care Fund may not be an ideal vehicle, but if the plans drawn up through it are broadly based, they can provide the right platform.
Improving mutual understanding for collaborative working
One finding to emerge from the series of ten round tables was that the knowledge and understanding which health and local government finance staff bring to each other’s agendas can often be limited. That is probably truer now than it was 20 years ago due to both the increasing complexity of the respective finance agendas and the reduction in career movement between the two sectors. That can lead to misunderstandings or missed opportunities in partnership working.
Mindful of that, CIPFA is developing a range of information and training which can be delivered in multiple ways to cover both leadership and practitioner levels – the idea being to improve awareness and insight by explaining the key features of local government finance to health finance staff, and the key features health finance to local government finance staff. The approach will be launched at CIPFA’s Health and Social Care Conference on 21 October in Manchester.
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