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Should health and social care be brought together?

David Cameron last week ordered health and social care services to be brought together, in a move which government advisers are calling the NHS’s most urgent overhaul, a report by The King’s Fund and the Nuffield Trust has revealed.

Efforts to bring the separate hospital care and local authority social care systems closer together have been taking place for some time, but it is understood that Cameron has now told Andrew Lansley to formally merge the two areas and drive through the changes that health policy experts are claiming will make life more convenient for patients, improve care and save money and is essential if the NHS is to meet the needs of an ageing population.

However, the pro-integration NHS Confederation which represents hospitals and other major NHS employers has warned that these changes will lead to some hospitals closing.

The prime minister was persuaded by senior doctors and Downing Street health advisers who claimed that, without integration, the NHS could become unsustainable due to rises in the number of patients with long-term health conditions such as obesity, diabetes and breathing problems.

The first move towards creating joined-up services is likely to see Lansley tell the NHS that it has to give integration the same priority that keeping waiting lists under control has had for the last decade. This would oblige providers of medical care to start working closely with social care providers in order to streamline the care patients receive, ensuring they have to deal with fewer organisations and delivering more care in community settings rather than hospitals.

The Department of Health is urged to make a ‘compelling case’ for change and to create an environment where integrating care is a ‘must do’, both for the NHS and local authorities. This, the report said, was “essential” to overcome the current NHS management culture which can discourage innovation and risk.

“Integrating care will improve services, particularly for people who are frail and those with long term conditions”, the confederation’s deputy policy director, Jo Webber, said. “But it will also involve making some really difficult decisions as hospital activity is reduced and moved into the community.”

Although “integration will produce more sustainable models of care in the long term”, she added, “many local initiatives could mean new services being run in tandem while old ones are shut, which could be more expensive in the short term.”

Health and social care is already integrated in Northern Ireland and a few parts of England, such as Torbay in Devon, and patients generally report greater happiness with their care where it exists.

Andy Burnham MP, the shadow health secretary, backed the report and said it was further proof that the government should drop its health and social care bill, which would set back the cause of integration by 10 years.

“Integrated care can be delivered without further legislative change or structural upheaval and would be embraced by the professions and NHS staff”, chief executive of The King’s Fund, Chris Ham said.

“Our ambition for the NHS and social care is a simple one – to achieve better results for people and carers”, Care services minister Paul Burstow said. “So our priority is to orientate the whole system around patients, service users and carers through our Outcomes Framework.”

Nuffield Trust director Dr Jennifer Dixon added: “Let’s make integrated care real for patients, particularly older people – it is about time.”

• Do you think this will meet all the needs of the ageing population?
• What effect, if any, do you think this will have on healthcare?