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A lack of national support risks making local integration mission improbable

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Last week’s NHS Confederation conference opened with a session on integration featuring Sir Howard Bernstein and closed with a speech from NHS England’s chief executive in which he called for any extra government funding to go to social care rather health.

But although Simon Stevens’ recognition of the centrality of a sustainable social care system to the future of the NHS is heartening, it will take more than warm words to solve the current crisis.

Mr Stevens’ views were reflected in a snapshot survey of LGC and Health Service Journal readers in the weeks running up to the conference in which 84% said social care or public health and prevention should be prioritised for extra cash over the NHS.

But more than half the respondents to the survey highlighted a lack of clear shared governance structures between health and local government and the immaturity of local relationships as barriers to developing sustainability and transformation plans.

Speaking at the conference, Manchester City Council chief executive Sir Howard Bernstein made a passionate plea for other areas to adopt Greater Manchester’s approach and “move to a single commissioning hub for all public services”.

The government last year tasked councils and the NHS with developing integrated services by 2020.

Lewisham & Greenwich NHS Trust chair Elizabeth Butler said the five-year window was “credible” but “enablers” were hard to establish, adding her trust and partners had spent years building an integrated IT system to enable organisations to communicate and plan effectively.

The conference also heard how lack of funding was a challenge, an issue cited as a barrier to developing STPs by just under half of the 73 respondents.

That financial warning was brought into sharp focus by Anita Charlesworth, director of research and economics at the Health Foundation, who reminded the audience that the NHS must save £22bn over the next five years.

She said the system was currently functioning in “relative plenty” compared with what is to come.

She added the overall savings included £15bn that must be found locally, of which about £1bn is currently “in the bag”.

Asked what would help make their local system more sustainable, almost half of respondents to LGC’s survey cited the creation of a single accountable care organisation while 37% thought Greater Manchester style devolution could make the difference. There was less support for handing social care to the NHS or increased local government involvement in running the health service.

Lord Prior, minister for NHS productivity and former Care Quality Commission chair, told the conference “we would have been moving quickly” if 20-25% of the country were served by integrated care organisations by 2020.

When many are looking for reassurance as they seek to implement radical change, some delegates bemoaned a lack of support from government.

Again this feeling was reflected in the survey. Asked to rate the extent to which national policy supported integration, the average response was just four out of 10.

This sense of unease would have been compounded by health secretary Jeremy Hunt, who only mentioned social care in passing during his conference address and gave insubstantial responses to questions from the audience on what he termed “Simon’s STPs”.

While many now accept the five year deadline for integration and sustainability across the country may have become aspirational rather than set in stone, there was a strong sense from the conference that the majority of delegates were behind far-reaching service transformation.

The conference also saw the launch of a joint report by the confederation and the Local Government Association, which outlined a joint vision for delivering a sustainable health and social care system in the next five years.

Offering advice on the successful integration of services and a call for sector leaders to “step up”, the implication is there are still many barriers to overcome and more effort required in order to achieve what some consider to be mission improbable.

But the urgency that the conference heard so much about risks being undermined by perceived complacency in government and critical financial challenges ahead.

 

How could national policy change to help facilitate integrated care? Frontline views

“The role of elected members should be clearly defined so they can make a positive input at the right time, but not then scupper years of hard work“

“Revisiting the ludicrous STP footprint”

 “Stop being so centrally prescriptive”

 “Align payment mechanisms and regulatory frameworks”

 “Redesign the STP process to align to local government”

 “Development of a cadre of leaders who have worked across both NHS and local government”

 “Policy OK. It is local politics and vested interest that get in the way”

 “Allow time for change to happen”

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