Adult social care needs a costed 10-year plan otherwise there is no prospect of integrating services with the NHS and improving outcomes for vulnerable people, an influential committee of MPs has said.
A report published today by the Public Accounts Committee said the government currently has no effective strategy to achieve its stated aim of fully integrated care provision, with the perilous state of local government finances a key barrier to progress.
The PAC has also called on the government to consider legislative change to remove barriers to integration, such as the current focus on requiring individual organisations to balance their books which makes it difficult for budgets to be pooled.
The report described “a profound lack of transparency and accountability in local health and social care systems” and raised concerns that sustainability and transformation partnerships are “side-lining” statutory health and wellbeing boards.
The committee also called for the Department of Health & Social Care and the Ministry of Housing, Communities & Local Government to set out how local leadership can be developed consistently as the “quality and effectiveness” is currently variable and stifling system-wide improvements.
It added: “Locally the mix and will of personalities is crucial, and there are not sufficient incentives to make leaders work together. The different regulatory regimes mean that these are often perceived to be a barrier to co-working.”
The PAC also expressed concern that DHSC and the ministry are not doing enough to tackle the variation in pay and conditions between the NHS and social care.
PAC chair Meg Hillier (Lab) said “the time for warm words and wishful thinking is over”.
She added: “Social care has suffered long-term underfunding and it is unacceptable that councils, under considerable financial pressure and facing growing demand for care services, must wait until 2020 for clarity.
“Government must also step up efforts to break down barriers to integration across the country.
“Its departments and agencies need to work together more effectively to support the roll-out of best practice, as well as the leadership necessary to drive change at local level.”
Responding to the report Ian Hudspeth (Con), chair of the Local Government Association’s community wellbeing board, said: “It’s important that integration is not seen as an end in itself but as a means to achieving better services and health and wellbeing outcomes, which is why local leadership, across local government and the NHS, is crucial to making sure that health and social care work most effectively for the communities they serve.
”We also need to make sure that national targets and conditions do not divert attention from the support that locally-led solutions, and a long-term funding plan, could provide for residents who need care.”
Association of directors of adult social services president Glen Garrod said increasing funding for the NHS without investing in social care ”is like pouring water down a sink with no plug in”.
He added: “We support a strong focus on a local, democratically accountable, approach – it’s important that we strengthen health and wellbeing boards to enable elected local leaders to play a vital role in shaping integrated services alongside NHS colleagues.
”But our starting point cannot be the system – it must be the person who needs care and support, so it’s essential that “integrated care” focuses first and foremost on their experience and aspirations, including looking at social aspects of their needs, including housing and loneliness.”