The Committee adds its own authoritative weight to the well-documented arguments on the deficiencies of the current system and wastes no time in pinning its colours to the mast of 'a well-funded, fully integrated system of care, support, health, housing and other services, not just to provide high-quality support for individuals, carers and families, but also to provide good value to the exchequer and the taxpayer'. It echoes much of the thinking in our recent report with the Nuffield Trust for the NHS Future Forum.
A striking feature of the report is that it quickly moves beyond simply defining the problem to advancing some specific and ambitious solutions. It calls for the creation of integrated local commissioning for services for older people; the adoption of a single outcomes framework instead of the three existing separate ones; and for the government to act on the Dilnot Commission recommendations and address the funding gap in social care (clearly unimpressed by the apparent assertion by the care services minister that said gap did not exist). It is good to see housing – a much-neglected component of the health and care spectrum – get some airtime thanks to the evidence of the National Housing Federation and others. And the Committee has overcome its earlier scepticism about health and wellbeing boards by emphasising their role in promoting integration, an emerging finding from our own research.
But some places have made good progress in developing integrated commissioning, only to see their efforts threatened by PCT clustering. This illustrates just how hard it will be to achieve genuine integration in a hostile climate of complex organisational change. And while the Committee is right that local integration should be mirrored nationally by the government 'regularly rebalancing spending across health, housing and care services', this will be hugely difficult when social care spending (£8 billion) is just a tiny sliver of all public spending on older people (£145 billion) and there is no spending review in sight.
A further challenge is the social care funding gap and finding a fair way of sharing the rising costs of an ageing population – something politicians could not agree about during the economic good times. The Dilnot Commission has offered a sensible and widely supported framework to move this forward, but finding the money demands tough trade-offs that cast dark political shadows.
These are long-term challenges that will endure long beyond the topical controversy about the NHS reforms. Everyone agrees that to meet the needs of an ageing population and to transform the experience of people with long-term conditions, integrated care is vital. It should be given the same priority over the next decade as NHS waiting times was given over the last. The social care White Paper expected in the spring offers a great opportunity to move beyond warm words and set out a compelling case for change.