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You can find the current article at its original source at https://www.theguardian.com/social-care-network/2018/jun/12/health-care-services-integration-suspicion
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| Public suspicious of moves to join up health and care services | Public suspicious of moves to join up health and care services |
| (5 months later) | |
| The Commons health and social care committee has – over many years and under successive chairs – been concerned by the fragmentation and poor coordination of care and health services. Its latest report adds to this scrutiny, focusing on the approaches to developing new integrated ways of planning and delivering health and care services. | The Commons health and social care committee has – over many years and under successive chairs – been concerned by the fragmentation and poor coordination of care and health services. Its latest report adds to this scrutiny, focusing on the approaches to developing new integrated ways of planning and delivering health and care services. |
| Sustainability and transformation partnerships (STPs), integrated care systems (ICSs), integrated care partnerships (ICPs) and accountable care systems (ACOs) all arose from the NHS Five Year Forward View. | Sustainability and transformation partnerships (STPs), integrated care systems (ICSs), integrated care partnerships (ICPs) and accountable care systems (ACOs) all arose from the NHS Five Year Forward View. |
| The committee’s timely and measured analysis emphasises that while moving “from a competitive landscape of autonomous providers towards more integrated, collaborative and place-based care” is supported, the changes have been hampered by poor communication “and a confusing acronym spaghetti of changing titles and terminology”. | The committee’s timely and measured analysis emphasises that while moving “from a competitive landscape of autonomous providers towards more integrated, collaborative and place-based care” is supported, the changes have been hampered by poor communication “and a confusing acronym spaghetti of changing titles and terminology”. |
| The demands of meeting transformation requirements are unrealistic at best and naive at worst. | The demands of meeting transformation requirements are unrealistic at best and naive at worst. |
| It is little wonder that when the changes and new models are poorly understood by those working in the system, “a climate of suspicion” among the public has developed about their purpose and there have been missed opportunities to co-design local systems to work more effectively. | It is little wonder that when the changes and new models are poorly understood by those working in the system, “a climate of suspicion” among the public has developed about their purpose and there have been missed opportunities to co-design local systems to work more effectively. |
| The report is also critical on a more fundamental level about the means and ends of reform. It joins the voices of others – including the National Audit Office – in underlining the continued barriers to integration and the lack of adequate oversight and governance of new initiatives. | The report is also critical on a more fundamental level about the means and ends of reform. It joins the voices of others – including the National Audit Office – in underlining the continued barriers to integration and the lack of adequate oversight and governance of new initiatives. |
| Nigel Edwards, chief executive of the Nuffield Trust, emphasised that the Department of Health displays an “optimism bias” that fails to appreciate the scale and nature of changes required. Indeed, change is largely about behaviour and practice and he told the committee: “There is very little way of accelerating that process; it has to be learned and developed.” Without sufficient understanding of these dynamics, the current model to drive integration is significantly, and perhaps fatally, flawed. | Nigel Edwards, chief executive of the Nuffield Trust, emphasised that the Department of Health displays an “optimism bias” that fails to appreciate the scale and nature of changes required. Indeed, change is largely about behaviour and practice and he told the committee: “There is very little way of accelerating that process; it has to be learned and developed.” Without sufficient understanding of these dynamics, the current model to drive integration is significantly, and perhaps fatally, flawed. |
| Despite the NHS’s long – and not very glorious – track record of seeking improved integration, the latest reforms once again point to the absence of evidence-based policy making, and instead are an example of a “cart before the horse” model of launching reform with little foundation and expecting comprehensive and expedient roll-out. Furthermore, in the face of continued funding and workforce pressures on the care and health system, the demands of meeting transformation requirements are unrealistic at best, and naive at worst. | Despite the NHS’s long – and not very glorious – track record of seeking improved integration, the latest reforms once again point to the absence of evidence-based policy making, and instead are an example of a “cart before the horse” model of launching reform with little foundation and expecting comprehensive and expedient roll-out. Furthermore, in the face of continued funding and workforce pressures on the care and health system, the demands of meeting transformation requirements are unrealistic at best, and naive at worst. |
| This is a model of change that has been poorly communicated and presented. There is little public awareness or understanding of STPs, ICSs or ICPs, and consequent suspicion and concern that reform represents privatisation by the back door. The committee observes that this has not been helped by communication or the language of accountable care, “neither of which have been adequately or meaningfully co-designed or consulted on with the public or their local representatives”. | This is a model of change that has been poorly communicated and presented. There is little public awareness or understanding of STPs, ICSs or ICPs, and consequent suspicion and concern that reform represents privatisation by the back door. The committee observes that this has not been helped by communication or the language of accountable care, “neither of which have been adequately or meaningfully co-designed or consulted on with the public or their local representatives”. |
| Nonetheless, the committee does not believe that STPs and ICSs are – as many fear – a smokescreen for cuts, but sees them as “a pragmatic response to the current pressures on the system”. But, and this is a crucial caveat: | Nonetheless, the committee does not believe that STPs and ICSs are – as many fear – a smokescreen for cuts, but sees them as “a pragmatic response to the current pressures on the system”. But, and this is a crucial caveat: |
| ... these mechanisms are not a substitute for adequate funding of the system. Funding them properly, including access to ring-fenced transformation money, is necessary and would allow a far better assessment of their potential. | ... these mechanisms are not a substitute for adequate funding of the system. Funding them properly, including access to ring-fenced transformation money, is necessary and would allow a far better assessment of their potential. |
| Instead, it is argued, neither the NHS nor local authorities have been given adequate investment, support or time to deliver the scale of transformation envisaged. Without such provision – including the capacity of staff to redesign services and systems, and double-running new services while old ones are decommissioned – this is surely not only an impossible demand on services, but is setting up a model that is destined to fail before it is properly tested and explored. | Instead, it is argued, neither the NHS nor local authorities have been given adequate investment, support or time to deliver the scale of transformation envisaged. Without such provision – including the capacity of staff to redesign services and systems, and double-running new services while old ones are decommissioned – this is surely not only an impossible demand on services, but is setting up a model that is destined to fail before it is properly tested and explored. |
| The committee concluded the national objectives around transformation (as set out in the Five Year Forward View and Next Steps documents) are not being reflected or supported by the demands of NHS England, NHS Improvement, Health Education England and the Care Quality Commission. Indeed, “incoherence in the approach of national bodies is a key factor holding back progress”. | The committee concluded the national objectives around transformation (as set out in the Five Year Forward View and Next Steps documents) are not being reflected or supported by the demands of NHS England, NHS Improvement, Health Education England and the Care Quality Commission. Indeed, “incoherence in the approach of national bodies is a key factor holding back progress”. |
| If there is to be genuine transformation, it has to be supported by a coherent national strategy embedded in the governance and regulatory DNA of the system. Some of this will require new legislation to remove barriers, and the committee is adamant that the purpose should be to address problems identified at a local level and should be led by the local health and care community. | If there is to be genuine transformation, it has to be supported by a coherent national strategy embedded in the governance and regulatory DNA of the system. Some of this will require new legislation to remove barriers, and the committee is adamant that the purpose should be to address problems identified at a local level and should be led by the local health and care community. |
| The case for any further changes, legislation or new regional and local structures might however be considered by asking a simple question: “For what purpose?” | The case for any further changes, legislation or new regional and local structures might however be considered by asking a simple question: “For what purpose?” |
| The committee concludes that any changes are a means to achieving “more coordinated, person-centred and holistic care for patients, particularly patients with long-term conditions”. If this objective is not served, and better care is not the result, the pursuit of integration is not just an article of faith but a major and costly distraction. | The committee concludes that any changes are a means to achieving “more coordinated, person-centred and holistic care for patients, particularly patients with long-term conditions”. If this objective is not served, and better care is not the result, the pursuit of integration is not just an article of faith but a major and costly distraction. |
| Melanie Henwood is an independent social care consultant | Melanie Henwood is an independent social care consultant |
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