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, or the extent to which services are integrated.
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.
The report, Integrating health and social care: A comparison of policy and progress across the four countries of the UK finds:
- Similar integration policies followed by England, Wales and Scotland have not led to any meaningful improvement in satisfaction with care and support, improvements in delayed transfers of care have not been sustained and the age-adjusted rate of emergency admissions to hospitals has not fallen. Data available varied between countries and was more limited for Northern Ireland.
- These efforts have failed to overcome longstanding barriers to support more joined up working, or provide for the resources, infrastructure and necessary staff to meaningfully integrate services and move more care out of hospitals. The maturity of relationships and partnership-working are more important to systems working well together than shuffling or changing organisational structures.
- There is limited evidence that pooling budgets across health and social care has created savings and financial savings should not be the primary goal of integration policies.
- While short-term funding has enabled some change the constraints on funding from the government in broader health and social care services has been a limiting factor.
- While each country in the UK have significantly different approaches to how health and social care are organised, each nation has attempted to drive integrated care delivery by changing the way services are planned, financed and commissioned in hopes that more coordinated service delivery will naturally follow.
- Not enough consideration has been made of different cultures and priorities across health and social care or to broader economic or political contexts that have impacted how integration is delivered.
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, 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: “That over 20 years of reforms has translated into only modest improvements for patients across each country of the UK raises important questions about what integrated care can realistically achieve, and why countries with significant contextual differences appear to end up with similar results.
“Part of the explanation may be that policymakers have continuously fallen back on the same financial and structural levers to encourage integration, including short term funding pilots, setting up joint boards and committees, and pooling budgets. Often these initiatives have failed to learn from or build on the efforts that came before it, or address the broader culture, incentives, and infrastructure needed to make integration work.
“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.”