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NHS needs long-term solutions not short-term fixes

Select committee criticises current response to Nicholson challenge

Louise Prime

Tuesday, 19 March 2013

Quicker progress in integrating health and social services must be made to avoid breakdown of the health and social care system, the Health Committee has warned this morning. Chair of the cross-party group of MPs, former health secretary Stephen Dorrell, called for “transformation of care through genuine and sustained service integration” and for health and social care services to better focus on meeting the needs of individual patients.

The Committee reported that current responses to the Nicholson Challenge are too often short-term fixes rather than sustainable, long-term service transformations. It called for re-imagination of health and social care services to ensure that “precious” NHS values are in future reflected in practice, which was welcomed by both the NHS Confederation and the King’s Fund.

The report warned that the NHS will no longer be able to depend on making savings through staff pay restraint, once current restrictions on public sector pay are relaxed in April 2013. It said that although pay restraint has helped make short-term savings, it may not be regarded as a sustainable form of “efficiency gain”.

Mr Dorrell pointed out that public expenditure on health and social care services is unlikely to increase significantly in the foreseeable future. He said: “This means that the only way to sustain or improve present service levels in the NHS will be to focus on a transformation of care through genuine and sustained service integration.

“Services should be designed to treat people rather than conditions. They need to respond to individuals rather than expecting individuals to find their way round a bewildering range of specialist departments.”

He called for a much more joined-up approach to commissioning health and social services, under the Health and Wellbeing Board, so that resources are efficiently shared rather than being regarded as “belonging” to one part of the system. But he added:

“Moving to this approach must not however result in less overall funding for care services.”

Mike Farrar, chief executive of the NHS Confederation, echoed the call for more radical solutions to improve care in the long-term, rather than short-term options. He said: “We can do much more to create a modern, affordable system that works in the best interests of patients. Getting this right may require some difficult decisions, including centralising some services, and moving others out of hospitals and into people’s homes. To make these changes work we will need strong political will and public support, putting forward robust, evidence-based clinical and financial cases for change.”

John Appleby, chief economist at The King’s Fund said: “Despite high-level political commitment, there has been a lack of urgency in developing integrated care – this now needs to happen at scale and pace …

“This should include making better use of existing resources by bringing together health and social care budgets locally and moving towards a single, strategic assessment of the funding needs of the NHS and social care in future spending reviews.”

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