Integration will not save money, HSJ commission concludes

This is the chief conclusion of the HSJ/Serco Commission on Hospital Care for Frail Older People, which also criticises the coalition’s flagship integration project, the better care fund, as having been planned in a “hokey cokey” fashion.

Formed by an influential group of health leaders, the commission says it supports efforts to integrate health and social care but warns that doing so will not ease cost pressures or reduce reliance on hospital beds.

“There is a myth that providing more and better care for frail older people in the community, increasing integration between health and social care services and pooling health and social care budgets will lead to significant, cashable financial savings in the acute hospital sector and across health economies,” the report states. “The commission found no evidence that these assumptions are true.”

The commission’s main report calls for more “realism” in debates over the NHS budget, which it says is “apparently expected to meet rising demand without appropriate real terms increases”.

Providers’ focus on cutting costs left them little room to explore new means of improving  care, the  report adds.

“If all attention is focused on the ‘slash and burn’ of cost improvement programmes, providers may be failing to see that they could… work differently and have better outcomes,” it adds.

“The rising tide of demand is squeezing everything, including fees for independent care, in individuals’ homes and in care homes.”

Members of the commission, which was chaired by University Hospitals Birmingham Foundation Trust chief executive Dame Julie Moore, were concerned about the “prevalence of magical thinking in current policy and politics”, according to their report. Integration is seen as a “‘silver bullet’ to slay the demon of poor care”, they warn.

“We described this as a Messiah concept,” it adds.

Commission member and consultant geriatrician David Oliver said the increasing ageing population indicated demand for acute beds would rise rather than decrease even if the health and social care integration drive succeeded.

“While we can all agree that if we invested more in prevention, in services outside hospital, in better management of long term conditions, then we could keep more older people away from hospital at the same time there’s no realistic prospect any time in the near future of reducing the big demand on acute hospital beds,” he added.

Professor Oliver said the NHS should pursue best practice in older people’s care rather than wait for government to dictate what they should do.

“Despite the lack of money and lack of organisation, right now within the NHS there are loads of examples of people doing the right thing,” he added.

“This notion that people keep pushing that innovation can only come from letting the market in - NHS people are innovating now and its working.

“What we should be doing is adopting some of those best practice models at pace.”