The government must act quickly to take the health and social care system out of “survival mode”, with “extreme” financial and workforce pressures undermining efforts to integrate services, a committee of MPs has said.
A report published today by the Commons health and social care committee found the scale of the ambition to develop closer collaboration across the NHS and social care system “has not been matched by the time and resources required to deliver it”.
The committee examined the development of integration since the publication of the NHS Five Year Forward View in 2014.
It found the 44 sustainability and transformation plans and partnerships (STPs) are now at different stages of developing integrated care systems, with funding and workforce pressures affecting “almost every area”.
The report said: “Some areas have made considerable progress in light of these pressures, but those furthest behind are struggling with rising day-to-day pressures let alone transforming care.”
It adds the process has been hampered by poor communication and “a confusing acronym spaghetti of changing titles and terminology” which is “poorly understood even by those working within the system”.
The report said this has “fuelled a climate of suspicion about the underlying purpose of the proposals”.
It adds a cohort of 10 integrated care systems had been developed by the best-performing STPs which have made good progress in ”difficult circumstances”, but they are “nascent and fragile”.
The report says the accountable care organisation (ACO) model, which would entail a single organisation holding a contract for up to 15 years to deliver health and care across a large population, must be subject to “careful evaluation”.
It also says ACOs should be NHS bodies rather than private organisations due the risk of possible collapse and the public’s preference for the principle of the NHS being in public ownership.
The committee said the government’s pledge of a long-term funding settlement for the NHS should be used to improve the delivery of joined-up services, with a national strategy backed by a ring-fenced transformation fund.
It adds: “The government and national bodies must act quickly to take the health and social care system out of survival mode and onto a more sustainable long-term footing.
“The current financial and workforce shortfalls present the greatest threat to successful transformation as organisations under extreme pressure have no space for reform.”
The report adds legislative change should be considered in several areas, including those affecting procurement and the Care Quality Commission’s regulatory powers.
Responding to the report, chair of the Local Government Association’s community wellbeing board Izzi Seccombe (Con) said the committee’s recognition that the government and NHS need to make a clearer case for integration was welcome.
She added: “The long-term future of the NHS can only be assured if social care is adequately funded in the short and long-term, with both services put on an equal footing which will improve prevention work and better manage demands on councils and hospitals.
“Further integration needs to ensure adult social care is appropriately funded within a wider system and focuses on the significant challenges and long-term sustainability of social care, which the forthcoming green paper needs to address.”