Response: Thought leaders agree that DHSC’s push to integration is welcome but stress importance of minimising disruption

Following the publication of the Department of Health and Social Care’s (DHSC’s) integration whitepaper, which details its proposals for a more joined-up and efficient health and social care system, leaders from NHS Confederation, County Councils Network, and Health Foundation have weighed in.

‘Joining up care for people, places and populations’ largely focuses on setting shared outcomes across the NHS and local authorities, making local leaders accountable for delivering against these outcomes, pooling budgets, and giving patients better digital access to information about how well local services are performing and a single digital care record.

Cllr Martin Tett, Adult Social Care Spokesperson for the County Councils Network (CCN), said that the whitepaper is another important step on the integration journey that the NHS and councils have been working towards for years.

He commented that the prospect of more easy pooling of budgets across the NHS and councils is welcome, along with more efficient use and sharing of data.

“Whilst further funding will be needed to maximise the success of these proposals, not least in establishing an effective intermediate care offer jointly with the NHS, this is a whitepaper that recognises county authorities’ role in shaping their local health systems. We must now be given the tools to make this a reality,” he added.

“With county authorities offering the scale as place leaders in bringing together key public sector partners, it is critical that an individual from local government should be the ‘single accountable person’ to lead on Integrated Care Partnerships.

“Those upper-tier authorities should also be the ones who lead on devising the most effective local structures to focus on improving community care options and tackling the wider determinants of poor health, working alongside primary care partners.”

Hugh Alderwick, Head of Policy at the Health Foundation, agreed that the overall focus on closer integration across health and social care is welcome and builds on the progress that the NHS and local authorities have made. He also underlined that the UK Government is right in acknowledging that there is no single approach that will work everywhere in England.

However, he warned that there is a lack of clarity surrounding what these changes mean in practice, and that there is also no clear guidance about the relationship between this whitepaper and some of the other changes happening across the NHS.

“But it is vague on what the changes may mean in practice and risks overclaiming what integration can achieve,” Hugh said. “There is also a risk of confusion, given the NHS in England is already being reorganised through the Health and Care Bill currently being debated in Parliament. The relationship between these different changes is not always clear.

“The proposal for single leaders for health and social care in local ‘places’ sounds simple but may cause disruption and added layers of management – and the fundamental differences between how the NHS and social care systems work will remain intact. Making collaboration work in practice depends as much on culture, management, resources, and other factors as it does on changes to structures and lines of accountability.”

He also underlined that more joined-up services is “no replacement for properly funding them”.

“The social care system in England is on its knees and central government funding over the coming years is barely enough to meet growing demand for care – let alone expand and improve the system,” continued Hugh.

“More integration is also little good if there aren’t enough staff to deliver services. Staffing shortages in health and social care are chronic, yet government has no long-term plan to address them.”

In addition, Matthew Taylor, Chief Executive of the NHS Confederation, underlined the COVID-19 pandemic has shown the importance of having interlinked health and social care services, and that it is “vital” to speed up ways of integrated ways of working.

He said that the proposals to breaking down barriers between NHS and local authorities, including through better data sharing, will be a big step forward. However, he reinforced that integration is not a new concept, and that it has been happening on the ground for “many years”.

Matthew added: “There have been rumours that the government was going to force mergers or pooled budgets as a way of appointing a single accountable person who would be responsible for planning health and care services in each local area. We are glad that the government has resisted this approach as it would have led to needless disruption at a time when the NHS needs to focus on recovering services as quickly as possible.

“As these proposals are developed further, it is important that we recognise the differences that exist in local areas including in local relationships. They will need to evolve in their own way if we are to crack this agenda.

“Finally, for integration to work there needs to be joined up thinking across government as well as at local level. Ensuring this will allow local leaders the freedom to work with their communities to identify what will provide the best outcomes for the public.”