The additional money for the NHS, announced by the chancellor in the Autumn Budget, was a fraction of the budget the service says it needs. Therefore, the integration agenda will continue to be heralded as the best method to achieve sustainability in the health and social care sector. Sustainability and Transformation Plans (STPs) will remain the favoured framework to deliver collaborative working.
Introduced in 2016, STPs are meant to bring together local health and social care partners to achieve financial balance by 2020, at the same time as improving outcomes. It is worrying then that a survey released this autumn, conducted by CIPFA and iMPOWER, highlighted that the organisations involved in STPs are struggling to integrate.
In the survey of 56 organisations, over half of respondents believe relationships between the NHS and local authorities to be "reasonable", less than a quarter consider them to be "very strong", with rather more believing them to be "limited". At the same time, 90% of those surveyed claim that they consider successful integration is critical to their organisation’s long term sustainability. This indicates that although health and social care partners recognise the importance of the integration agenda and are rather optimistic about its potential benefits, they are still not managing to break down the barriers to collaborative working.
There is no one clear reason why things have not improved since the introduction of STPs and other national mechanisms, such as the Better Care Fund (BCF). It may be due to a system-wide shortage of resources and capacity which is causing organisations to look inwards to protect budgets. Such thinking, despite being understandable, is akin to a prisoner’s dilemma or protectionist trading – if all seek to optimise their own bottom line, the effect on the collective bottom line (and so most organisations’ own positions) will be negative.
For integration to work, local partners should be open, transparent and realistic about what can be achieved and think in terms of the whole system, not just their organisation. This requires that the right staff with the appropriate attitudes and skillsets are in place, and for training to fill any gaps.
The government must take action too. Measures could include the introduction of financial incentives for STPs that can demonstrate successful integration. It would also help if, in the spirit of devolution, local partners were left to take forward the agenda without the distortions imposed by centrally-driven targets which, for example, may prioritise reductions in delayed transfers of care in preference to action to prevent admissions in the first place.
Many ways in which the government and local partners can better support integration require more resources – notably the investment upfront needed to facilitate transformation and take forward the preventative agenda, which links powerfully to integration. CIPFA has long called for health and social care funding to be linked to a percentage of GDP to help stabilise the position and make it easier to make such longer-term plans. But considering it is likely that the chancellor will ignore calls for an immediate cash injection, more funding for the sector does not seem likely. Integration then will then rely on local partners facilitating successful working relationships, which, in light of the results of the survey, seems a tall order in current circumstances.
This article first appeared in National Health Executive (NHE) magazine’s December edition.