Lip service has been paid to the need for prevention and integration in the NHS and social care system. Now more must be done to implement change on the ground, writes Mike Adamson, chief executive of the British Red Cross
We all know that the NHS and our social care system are under more pressure than ever before. It is essential that all of us with a passion for serving people in real need work together to identify ways of easing that burden.
Two solutions commonly claimed are prevention and integration. They sounds so simple and in some ways, they are. If we invest more in simple, powerful preventative services, fewer people will need more expensive, acute support. And if we integrate health with social care, more people will get the right support at the right time, avoiding an escalation of their needs.
While the language of prevention and integration is being emphasised locally, neither is being implemented meaningfully on the ground at the scale or pace required
The theory and, in part, the policy, has already been conceived. Prevention is a key component of both the Care Act 2014 and the NHS Five Year Forward View. Government intends to fully integrate health and social care by 2020, while sustainability and transformation plans are intended to drive forward both agendas at a local level.
So what’s missing? New British Red Cross research shows that, while the language of prevention and integration is being emphasised locally, neither is being implemented meaningfully on the ground at the scale or pace required to truly ease the pressure on our system.
Prevention? What’s prevention?
With more than 15 million people already living with long-term conditions in England – accounting for 70 per cent of the money we spend on health and social care – preventative interventions at all levels are essential so that they can live independently for longer.
The British Red Cross has been monitoring the implementation of the prevention agenda for several years. Previous Red Cross studies have shown that there is no consistent understanding of exactly what “prevention” is and how to put it into action. Rather, the system still focuses on reacting to crises rather than guardian against them.
Local health and social care decision-makers have expressed frustration at the difficulty they have in investing in preventative care and support with such stretched finances. This is despite recognition that prevention saves money in the long term.
Inconsistency of ambition
With such high hopes pinned on health and social integration as a way to improve outcomes and efficiency, our research set out to explore the understanding and prioritisation of the integration agenda at a local level too.
Like “prevention”, there seem to be different interpretations of “integration”. A review of sustainability and transformation plans, and responses to British Red Cross Freedom of Information requests concerning efforts to integrate social care with health, demonstrate an inconsistent appreciation of the value of integration.
While it was encouraging to read about a variety of actions already being taken, from pooling budgets to integrating teams and governance structures, many of these positive steps seem to be small in scale, often only affecting a small number of people or services, or only targeted at one group of people with a specific condition or illness.
Few actions have been implemented at scale and many have not been put in place across the board. Such inconsistency of ambition can only force us to question the coherence of the Government’s plans for full health and social care integration by 2020.
There is a willingness to implement change but it is crucial that local decision-makers are given the backing and resources they need
The forthcoming proposed green paper on social care offers a timely opportunity to explore what is needed to make integration work, at both local and national levels. Such a conversation should include an exploration of the resources needed to achieve the full ambition of integration as well as whether a legislative framework, as implemented in Scotland, is required to aid the process.
Our research shows that across England there is a willingness to implement change but it is crucial that local decision-makers are given the backing and resources they need if we are to see consistent and effective implementation in all parts of the country.
Cost effective, care effective
In the meantime, the sustainability and transformation planning process can act as another catalyst for prevention as well as integration. Our review found that the understanding and prioritisation of prevention in STPs is generally very strong. We must now make sure these plans for transformation can be put into practice on the ground.
At a time when a large proportion of the sustainability and transformation budget is being spent plugging deficits, we need to refocus and examine more thoroughly what prevention and integration can contribute in the way of both cost and care effectiveness.
There is still time – and certainly willingness on a local level – to achieve meaningful change… but the clock is ticking.