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The health and social care interface

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The National Audit Office (NAO) has today published a report assessing the challenges preventing health and social care from working together effectively. In a move to encourage the government to create a long-term plan for a sustainable, joined-up care sector, the head of the NAO, Amyas Morse, is urging further and faster progress towards a service that centres on the needs of individuals, meets growing demands for care and delivers value to the taxpayer.

Since the NHS was established in 1948, health and social care needs have changed significantly with an ageing population and greater demand for long-term care, but the separation between the health and care sectors has remained. The government has made slow progress towards its longstanding objective of changing the way these services are delivered through better integration, an objective reiterated in the NHS’s Five Year Forward View.

The NAO’s report draws together the NAO’s experience and unique perspective of auditing the NHS and local government’s approach to delivering health and social care. It aims to contribute to the ongoing debate about how to improve joint working across health and social care in England.

The report anticipates the green paper on the future funding of adult social care, now delayed until the autumn, and the planned 2019 Spending Review, which will set out funding allocations for both health and local government. It also acknowledges the government’s recent announcement of funding increases for the NHS up to 2023-24.

The NAO has set out why closer working between health and social care is important, as well as the key strategies and initiatives that government and NHS England have put in place. The report examines the challenges in bringing this about and the work being carried out nationally and locally to overcome these challenges. It also addresses some of the key financial challenges facing both the NHS and local government and how these impact on joined-up working, as well as cultural and structural barriers which hinder decision making, and strategic issues which inhibit central and local planning.

The report finds that the financial pressure that the NHS and local government are under makes closer working between them difficult and can divert them from focusing on efforts to transform services. Short-term funding arrangements and uncertainty about future funding make it more difficult for health and social care organisations to plan effectively. Although the report acknowledges the recent announcement of extra funding for the NHS, additional funding has, at times, been used to address financial pressures, rather than to make essential changes to services or adopt new technologies.

The report makes it clear that the NHS and local authorities operate in very different ways, and both sides can have a poor understanding of how decisions are made. Problems with sharing data across health and social care can prevent an individual’s care from being coordinated smoothly.

The report finds that new job roles and new ways of working could help to support person-centred care, but it is difficult to develop these because of the divide between health and social care workforces. A joint workforce strategy is currently in development. With social care now accounting for over 50% of local authorities’ overall spending, it is vital that the NHS and local government work effectively together to support person-centred care.

“No one across government or the civil service would disagree that health and social care have to be in balance to give people quality of life, and to use the available national and local resources as efficiently as possible. The hard part is agreeing how that balance is to be achieved and maintained, and who is willing to sacrifice what to bring it about. “The NHS did not like funds being syphoned off through the better care fund, whilst local government has reservations about sacrificing over half of its financial resources towards NHS England’s priorities, which risks eroding local democracy. The answer may lie in local flexibility, but that could leave serious gaps in delivering what is needed – an integrated service. Serious political leadership is needed.”

Amyas Morse, the head of the NAO, 4 July 2018

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