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Five-point plan to integrate health and social care

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To say ageing issues were at the top of our agenda in Essex would be, well, the understatement of the age.

We are already a ‘super-aged’ county, where one in five residents is over 65 – England as a whole won’t hit that figure for another decade at least. We had 44% more residents aged over 90 in the 2011 census than in 2001. We forecast that by 2030, the number of Essex residents needing care and support will be four times as many as today.

Essex is not alone in facing this care challenge. Nationally, NHS England predicts a £30bn gap between resources and demand in health alone by 2021. The gap for social care is estimated to be £7bn by 2020.

We are working hard in Essex with our health partners to look at how we can work more closely together and integrate health and social care. We have a particularly complex environment with five clinical commissioning groups, five acute trusts and two mental health trusts to work with; it is not easy.

We are making good and steady progress locally but some barriers are so huge and beyond our control that we need a policy change from national government. Policy change is needed not just to make integration easier (after all, integration is just a means to an end) but to lock in a sustainable health and social care system for the future. That is why we have just published A Shock to the System: Saving Our Health and Social Care. This sets out the five key actions we believe the next government must take to put health and social care onto a sustainable footing and to aid the process of integration.

The government must:

  • Allocate 10-year, place-based funding settlements to local areas for health, social care and public health. In Essex, this would be worth £3.5bn a year.
  • Empower local health and wellbeing boards to hold the place-based budget for an area and set strategic priorities and direct the commissioning of health and social care. This would require changes to the funding and accountability arrangements of health and wellbeing boards to give them teeth. A health and care commissioner (possibly elected) would be the chair of the board with a clear job description to drive integration and to improve health and social care outcomes in a local area. It would simplify arrangements in local areas.
  • The NHS tariff system needs to be reformed to incentivise prevention and align financial incentives for providers with health and social care outcomes for individuals.
  • The laws around data protection need modernising and clarifying. A legal presumption to share data, with safeguards, could build confidence. The Law Commission has recently proposed that there should be a full law reform project to create a principled and clear legal structure for data sharing. It argues that such a project should include work to map, modernise, simplify and clarify the statutory provisions that permit and control data sharing and review the common law. This seems a sensible way forward.
  • Most importantly, we need a sensible national conversation about what a universal service offer should look like, about how eligibility for health and social care services could be more aligned, and about how it could all be paid for. The King’s Fund’s recent independent commission is a worthwhile contribution to the debate and raises some interesting and workable ideas but it is important that the government, with backing from the other main political parties, leads the debate and engages with the public in an honest way to build understanding and consensus.

Essex believes that the implementation of these five measures can help put health and social care onto a sustainable footing. We recognise these will not be the only answer. The NHS and local government need to improve efficiency; the potential of technology needs to be radically explored and promoted in health and social care; and more needs to be done to ensure a steady supply of GPs.

We believe taking these five steps can help the next government make significant strides towards integrating health and social care and addressing the considerable pressures facing our health and social care systems. They represent a focused programme of action for the next government.

Local areas cannot tackle the fundamental problems confronting the health and social care system alone. The harsh reality is that not only are difficult decisions required but also that the most fundamental of these require decisions and policy change by national government. Decisions must be made about how the health and care system is funded and how it is accessed.

Local health and wellbeing boards and local councils simply do not have the legal authority to make the fundamental changes that may be required. It’s time to start getting honest about the structural weaknesses in our health and social care system.

Joanna Killian is the chief executive of Essex County Council



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