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Integration of health and social care lacks ‘transparency’

Report outlines a more joined-up approach to care

Jo Carlowe

Monday, 11 June 2018

The government has today been accused of “lacking transparency” in its efforts to fully integrate health and social care.

Responding to the publication of today’s Parliamentary report* by the Health and Social Care Committee on integrated care, British Medical Association council chair, Dr Chaand Nagpaul, said: “At a time when the NHS is buckling under the combined pressures of soaring demand, insufficient capacity and underinvestment, the BMA agrees in principle with a more joined-up approach, including greater collaboration within the health service, and between health and social care.

“However, it is clear that the way in which transformation plans are being rolled out lacks transparency and has made minimal genuine efforts to engage healthcare staff, patients and the public.

“From STPs to ACOs and now ICSs and ICPs, professionals and the wider population alike are left to navigate a maze of meaningless acronyms with little explanation. This report reflects a number of our concerns, including the lack of consultation and engagement surrounding such plans and the need for patient care to be put at the heart of any moves towards an integrated care system.”

He added: “As we addressed in evidence to the recent judicial review on ACOs, the BMA is concerned that such transformation plans will operate within current procurement rules, which risks handing an area’s NHS budget to private providers through competitive tendering. Added to this is the insecurity of fixed-term ACO contracts which will require re-bidding every 10 years and which a provider can terminate and walk away from early. We are pleased that the Committee agrees with the BMA’s call for legislative change to remove legal barriers imposed by the Health and Social Care Act 2012.

“The BMA has long been calling for the current damaging and wasteful competition regulations enshrined in the Act to be removed. The prime minister has outlined her intentions to draw up a long-term funding plan for the NHS, and this is an opportunity to ensure that resources better match expectations around achieving a more integrated service.”

The Richmond Group of Charities, a collaboration of 14 health and social care organisations including Diabetes UK, the Stroke Association, and Age UK, has welcomed the Select Committee’s report.

Dr Charlotte Augst, Richmond Group of Charities partnership director said: “At least 15 million people in England live with one or more long-term condition, and these people are the majority users of health and social care services.

“Continuity and consistency of care is hugely important to them. They need their GPs to be able to talk to hospital staff, and their pharmacists to know their carers. This group often also uses the support of charities; a person with advanced dementia might be in contact with dozens of professionals involved in their care. But too often their experience is made more stressful and less safe by fragmentation and a lack of join up between different service providers.

“The NHS has for years now been pursuing an integration agenda, under an ever-changing series of headings and initiatives, aiming to bring together the organisations that design and deliver health and care services.

“We welcome the Health and Care Select Committee’s conclusion that it is time to refocus the integration agenda on what really matters; giving people consistency in their care across all the services they use.

“Service users shouldn’t have to tell their story again and again; everyone involved in their care should understand what matters to them; and ultimately they should be supported to live as well as possible for as long as possible.

“The Committee describe this as the 'litmus test' for the integration agenda, and we await with interest to see out how NHS leaders and the government respond to this clear steer from the Committee.”

*Integrated care: organisations, partnerships and systems. A report prepared by the Health and Social Care Committee, June 2018.

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