On the 4th September, the independent Barker Commission on the Future of Health and Social Care in England published its final report and focused attention on the topic of integrated care. The messages are clear and simply presented on the King’s Funds illustrated summary.
In short, the line between healthcare and social care is becoming increasingly blurred as we live longer and develop multiple, parallel issues. The system as it stands us unfair meaning people with dementia may have to pay for their own care whereas those with cancer do not. The separate sources of funding, where spending on health comes from national taxation yet any publicly funded social care is paid by local authorities, means that spending varies across the country, with decisions over who pays for what being a constant bone of contention. The fact that the system is not co-ordinated results in inefficiency at both a financial and human level. The Commission therefore calls for radical change with a single ring-fenced budget, simplified pathways and an increased provision of “free” social care. As with anything worth doing there is a cost to all of this and the report recommends a package of taxation and charges which could be made to realise the proposals.
Of course this report is addressing the NHS in England and its worth bearing in mind that the structures and funding vary across the four nations of the UK. Wales and Scotland have long since departed from the internal market approach utilised in both England and Northern Ireland and arrangements are quite different. Scotland has been concentrating on this integrated care route for some time now with free personal care for those above pensionable age in place since 2002. There are still major challenges ahead however, as the Herald reports the bill to the taxpayer now sits at almost £500 million per year compare with £110 million just 10 year ago – a trend which is only ever going to go in one direction.
On 8th September, Monitor updated its Guidance on Enabling Integrated Care in the NHS in England. It recognises the current problem and the resulting confusion, repetition, delay, duplication and gaps in service delivery as well as people getting lost in the system. The organisation expresses the opinion that competition and integration are not mutually exclusive, that competition can exist with beneficial co-ordination. It draws attention to the legal obligations for organisations with an NHS provider licence and highlights the Integrated Care pioneers – fourteen local areas who have been selected to pioneer ambitious and innovative approaches to person-centred and co-ordinated care.
Any doctor preparing for a medical interview, whether for a new consultant position or as part of forthcoming ST process would do well to look into the topic, be they in one of the 14 pioneering areas or in some other part of the UK.
