Labour plan puts adult social care in NHS hands as ministers seek savings

The document, considered a trailer for Labour’s manifesto commitments on health policy, is due this week. It will outline a five year health strategy that follows a no holds barred consultation with the NHS on the changes required to national policy to help the NHS survive much lower funding growth.

One of the bits of evidence we do know is that the real productivity gains, the real quality and productivity gains in the future, are at the interface of secondary and primary care

As HSJ exclusively revealed on hsj.co.uk on Tuesday, one of the more radical proposals in the document will be for much greater NHS involvement in, and control over, adult social care.

The document will likely refer to “greater integration” and “pooled budgets” between the two services. But ministers are also planning to float the possibility of a wholesale transfer of adult social care to the NHS as part of Labour’s election offering. Health secretary Andy Burnham has pledged to make plans for a “national care service” a top issue with voters.

Although the proposal will be unpopular within local government, it will be welcomed by many in the NHS.

NHS Confederation deputy policy director Jo Webber said: “There are definite advantages to bringing health and social care closer. Anything which makes it easier for commissioners to develop more seamless care packages for patients and deliver better value for money for the taxpayer would be welcome.”

She said “too many” people were ending up in hospital when they really needed good quality social care at home. Bringing together the systems would help end that.

Picker Institute head of policy Don Redding agreed. Forthcoming research from the institute has found many older people avoid using social care services as they attach a “welfare” stigma to them. Merging them with the NHS could result in people being looked after in the most appropriate setting, he said.

The current split of responsibilities and funding means the health service and local government tend to “shunt” costs - and patients - between the two services.

Integration could remove the financial incentives to shunt costs and ensure patients were treated at the most efficient cost.

That point was made by NHS chief executive David Nicholson last month in a speech to medical directors.

He said: “One of the bits of evidence we do know is that the real productivity gains, the real quality and productivity gains in the future, are at the interface of secondary and primary care, at the interface between NHS and social care, at the interface between empowered patient and the service.”

He added: “We have got to think about how local government manages provision and whether we can integrate directly health and social care horizontally across the system.”

The five year strategy is also expected to set out expectations for radical improvements in productivity for community services, with targets to reduce unit costs year on year.

It follows as yet unpublished research for the NHS Institute for Innovation and Improvement, which estimates that by implementing its Productive Community Services programme, community service providers could increase their productivity by 28 per cent, measured in the number of patients visited.

If “cashed”, that saving would translate into £611m a year across the NHS, but it could also be used to free capacity to enable more patients to be treated in the community, for example by either increasing the numbers of patients seen or extending the average length of visits from 28 minutes to 46 minutes.

Separate research by the National Endowment for Science, Technology and the Arts argues that more than £6.9bn a year could be saved by increasing levels of self care and redesigning services to be more patient focused. That research was seized on by chief secretary to the Treasury Liam Byrne in his report Putting the Frontline First on Monday.  

Research co-author and NESTA director of public and social innovation Michael Harris told HSJ the vast majority of those savings were cashable as they stemmed from preventing or alleviating long term illness.

The Department of Health is also attempting to develop incentives to improve care for people with long term conditions by extending the scope of the CQUIN (commissioning for quality and innovation) payments.

HSJ and sister title Local Government Chronicle’s conference on Delivering Efficiencies in Adult Services is on 25 February 2010, www.lgc-adultefficiencies.com