Twenty years of reforms to join up health and care have made ‘little difference’ to service users

Nuffield Trust

Over 20 years of reforms to better join up health and social care services across the four UK nations have made “little difference” to patients and service users, according to an independent health think tank.

A report published by the Nuffield Trust finds there is limited evidence that similar policies pursued by the four UK nations – including pooling budgets and creating new integrated boards and committees – have dramatically improved patient experience, quality of services or supported the delivery of more care outside of hospitals.

As the government’s proposals for integrated health and care services continue their journey through parliament, the report warns without concurrent investment in social care and broader public service it is “very likely” the latest reforms will not yield the results ministers hope for.

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The report highlights that varying levels of financial resources in health and social care in each of the four countries has slowed efforts to reform, and there has been falling investment in housing, education and wider public services which all play in part in people’s health and wellbeing.

To overcome the cycle of failed initiatives, the authors urge policy-makers to shift focus away from organisational and structural reform and instead focus on the behaviours, incentives, skills and resources needed to integrate services at the front line.

Nuffield Trust Senior Fellow Sarah Reed, the co-author of the report, said: “There is also only so much integration is likely to achieve while there remains a significant mismatch in the funding and staffing available across health and social care. The ability for integration to improve population health will also be limited by broader factors that affect how able people are to live independent, healthy lives. These challenges require long-term solutions which cannot be solved alone by integrating services.

“Ultimately if we intend to create meaningful change for service users, then more attention must be paid to services themselves and the experiences of those who use them.”

Commenting on the report, Dr Jane Townson, CEO of the Homecare Association, said the findings are “not surprising”.

She explained: “Integration is ultimately meaningless without a change in culture and investment in all parts of the health and care system, including social care.”

Dr Townson continued: “We are very much in favour of changes to the social care system and support integration. People receiving health and care services often report difficulty accessing the help they need and can feel pushed from pillar to post. We need to do better.

“To make the system work in concert, all key players need to focus on those needing support, communicate effectively with each other, and have parity of esteem. And it goes without saying that we need enough key players in all parts of the system in the first place.

“Right now, the conditions to facilitate integration are not in place.”

Tags : integrationjoined up careNuffield Trust
Sarah Clarke

The author Sarah Clarke