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On 7 February, the National Audit Office published a substantial report on Health and Social Care Integration, which hit the headlines for its conclusion that integration has been slower and less successful than envisaged and has not delivered the expected benefits for patients, the NHS or local authorities.
As a result, the NAO concluded, the government’s requirement for integrated health and social care services to be in place across England by 2020 is at significant risk. Indeed, when the NAO’s Ashley MacDougall, who led on the study, spoke to the CIPFA/HFMA Integration Summit he indicated that this requirement had been dropped, although integration remains at the forefront of policy and of STPs as the primary means of taking it forward.
MacDougall emphasised that the NAO does not look at the efficacy of policy – it has and seeks to have no view on whether integration of health and social care is an effective policy decision. Rather, it seeks to assess whether the government is delivering on its policy aims. The report concludes that thus far progress appears to be mainly in attitudes and approaches rather than in measurable results:
Ninety percent of local areas agreed or strongly agreed that delivery of their BCF plan had improved joint working, but the BCF did not achieve the planned savings or performance targets.
Arguably, those plans and targets were always unrealistic, given they included targets to reduce emergency admissions to hospital and reduce delayed transfers of care, an achievement which would have required a major reversal of long-term trends.
Government has not yet tested integration at scale and is unable to provide any compelling evidence that integration leads to sustainable financial savings or reduce hospital activity.
The NAO draws similar conclusions of a lack of demonstrable results from the Integration Pioneers to date.
The report sets out 20 years of integration initiatives in a timeline indicating how policy shifts have increased the levels of complexity in the system which need to be navigated in order to move forward.
Where people have said integration has worked, indicated McDougall, it has taken a long time. The NAO recommend that the government needs to review its approach and put in place more appropriate national structures. The NAO’s conclusions are salutary, but consistent with views often expressed at local level: that integration is best seen as a good in itself for the users of more joined-up services, and the best means of enabling other improvement action to be taken forward - rather than as a solution in itself. STPs offer a sensible structure for doing that.