Re-think needed on health and social care outcomes, says The King's Fund

The King's Fund has called for a single performance framework to ensure that NHS and social care services work together to improve outcomes for patients and service users in a new paper published today.

Integrating health and social care: Where next? says that the government's NHS reforms offer an opportunity to integrate health and social care, but cautions that plans for separate outcomes frameworks for the NHS, social care and public health could threaten effective joint working at a local level, reducing benefits for patients and service users. The Fund is calling for the frameworks to be aligned, with a view to creating a single outcomes framework for all three services.

The report also highlights the potential for new health and wellbeing boards to improve joint working between health and social care. However, it warns that the boards, which are being set up under the government's health reforms to bring together the NHS and local authorities, will not have sufficient teeth to drive the integration of local services. As a result, the Fund is calling on MPs to amend the Health and Social Care Bill to give the boards stronger powers to ensure that new GP consortia and local authorities work closely together.

In a separate report also published today, the Fund highlights experience from Torbay, where local NHS and social care staff are delivering integrated care by working together in single teams with a pooled budget. New analysis undertaken for Integrating health and social care in Torbay: Improving care for Mrs Smith shows this has reduced daily hospital bed use by a third since 1998/99: Torbay performs well in reducing delaying transfers of care from hospital and achieving lower rates of emergency admissions for older people than areas with a similar demographic.

Chris Ham, Chief Executive of The King's Fund said:

'We know that people want care that feels joined up and seamlessly addresses their needs. We also know that this is not the reality many people experience when they come into contact with health and social care services. Getting services to work together is a key challenge in improving outcomes, especially for people with long-term conditions and older people with complex needs. The experience in Torbay shows what can be achieved by integrating local services – the policy changes we are suggesting would help make this the norm, rather than the exception.'

Read the reports: Integrating health and social care: Where next? and Integrating health and social care in Torbay: Improving care for Mrs Smith

Notes to editors: 

1. For further information or interviews, please contact The King's Fund press and public affairs office on 020 7307 2582 or on our out- of-hours mobile 07584 146035. An ISDN line is available for interviews on 020 7637 0185.

2. The King's Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help to shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.

3. Integrating health and social care: Where next? and Integrating health and social care in Torbay: Improving care for Mrs Smith will be launched at The King’s Fund event Integrated care: realising the vision on Thursday 31 March 2011 and will be available to download.

4. The three outcomes frameworks are as follows:

NHS outcomes framework Published 20 December 2010. The first NHS outcomes framework sets out the outcomes and corresponding indicators that will be used to hold the NHS Commissioning Board to account for the outcomes it delivers through commissioning health services from 2012/13. The framework sets direction of travel in the journey towards improving outcomes, and offers an opportunity for the NHS to begin to understand what an NHS focused on outcomes means for individuals, organisations and health economies.

Transparency in outcomes:a framework for adult social care Alongside the Social Care Vision, the Department of Health launched Transparency in Outcomes: a framework for adult social care - a consultation on a new strategic approach to quality and outcomes in adult social care. The consultation, which closed on February 9 2011 envisages an enabling framework which places outcomes at the heart of social care, improves quality in services, and empowers citizens to hold their councils to account for the services they provide. The next stage will be co-produced with partners, based on responses to this consultation.

Healthy Lives, Healthy People: transparency in outcomes, proposals for a public health outcomes framework The consultation is ongoing and closes on 31 March 2011.

5. Health and wellbeing boards will be responsible for producing joint strategic needs assessments and developing a joint health and well-being strategy for their local areas. The core members of HWBs will be GP consortia, the Director Adult Social Services, Director of Children’s Services, Director of Public Health and the local HealthWatch. However, HWBs have not been grated sufficient powers to meet the expectation that they will join up commissioning between the NHS and local authorities. For example, there is no requirement for them to have regard to their views.

6. Impact of integration in Torbay:

  • Average number of daily occupied hospital beds reduced from 750 to 528 in the ten years from 1998/9.
  • Lowest use of emergency hospital admissions in the region in 2009/10, 2025 bed days per thousand population compared to an average of 2778
  • Delayed hospital discharges have been reduced to a negligible number, with such patients readily identified and managed
  • Hospital stays (bed days) for older people with two or more admissions were reduced 2003-2008 by 24% for the over 75s and 32% for the over 85s, significantly out-performing peer-group comparators (47% of the average)
  • Progress has also been made in social care from a low base, as illustrated by:
    In the three years from 2007/8 TCT has been financially responsible for 144 fewer people over 65 in residential and nursing homes
  • There has been a corresponding increase in the use of home care services, some of which is now being targeted on preventive low-level support
  • The rate of use of Direct Payments is one of the best in the region.
  • The Care Quality Commission has judged Torbay to be “performing well” in 2010.