Health Select Committee weighs in to debate on social care

There was a time when a Health Select Committee report on social care would barely quicken the pulse of anyone other than sector insiders and the policy commentariat. But as the troubled Health and Social Care Bill returns to the House of Lords, and with the government's response to the Dilnot report on social care funding weeks away, the Committee under its current chair has form, so its latest report will be subject to forensic scrutiny.

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.

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Comments

#1056 Vinesh Kumar
Programme Manager - integration
London Borough of Redbridge

Richard, I am concerned about the 'payment by results' mechanism in acute settings and the perverse incentives through tariffs on bed usage etc...and even in light of overwhelming evidence about how older people could avoid being in acute settings and be supported in community settings in a cost-effective manner, there is no clear directive in terms of Integration, for example on what the Commissioning Support Organisations (CSO) should be looking at in terms of integrated care in their local area and recommending to CCGs and the strengthened role of H&W boards regarding Integration from DH (Strategic rather than a facilitative role) although King's fund and NHS Future Forum (and now the 14th Report) having given Integration a greater and clear profile.

I am not too optimistic about the forthcoming Social Care White paper's reference to Integration. Even if there is specific reference, what is expected from the NHS side??

I am reminded of this quote from the dramatist, Eugene Ionesco:
'Its not the answer that enlightens, but the question'....I think this time, the answer from DH needs to enlighten and empower us...about Integration!

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