Integrated health and care services have been the aim of central policies and local discussion for many years, and moves to decentralize health budgets to areas such as Manchester, and Cornwall are giving integration more of an incentive.
Recently, the Health Foundation has thought about ways to develop quality in both health and social care worlds considering how both sectors can be bought together to integrated care.
However, it should not be forgotten that there are stark differences between the two sectors. Whilst social care is delivered by many exclusive, often private and third sector organisations, NHS trusts are state run, large organisations, holding a lot of authority with local commissioners.
Furthermore, the general view seems to be that NHS providers are generally too big to fail, whereas social care providers regularly go out of business after tough CQC inspections. The NHS average wage is also much greater than most homecare providers, which struggle to pay more than minimum wage.
Such differences are also apparent in the approach taken to supporting quality improvement. In health, there is an unspoken assumption that the government holds responsibility for the quality of care delivered. As summarised by former health minister, Aneurin Bevan: “if a hospital bedpan is dropped in a hospital corridor in Tredegar, the reverberations should echo around Whitehall”.
One view seen by the Health Foundation contends how the NHS providers receive very little support as most of the attention is given to ‘payments systems and performance management’. Yet, as a nation we still like to believe that NHS transformation goes beyond providers themselves, requiring the help of national and local support systems.
In social care, it is quite different. The purchaser-provider split has truly transformed how social care is delivered – enhanced by the condition to provide choice and control for service users.
As more care is being delivered by the voluntary and private sector, support in social care is more and more being seen as the concern of providers themselves. Furthermore, it is mostly given through ‘good practice guidance’ offered by organisations such as the Social Care Institute for Excellence, Think Local Act Personal and Skills for Care
Thus, in health there is appreciation that development takes support beyond the margins of providers yet, in social care this is far from the case. But why? Perhaps as a nation we feel as though we should support the improvement of publicly owned organisations and assume that privately owned organisations sort themselves out.
Scale is also an important factor to consider. Health care has a dominant national and regional element, whereas social care focuses mostly on the market within a council. Also, as the performance of the NHS is more open and transparent to the public than social care, more attention is given to it.
Many agree that despite the differences outlined above, health and social care can and should learn from each other. As argued by the Health Foundation – ‘the focus on peer support and learning in social care could usefully be picked up by health, including support for commissioners. And in social care, more support for providers could allow them headspace to look beyond the day to day, and regional coordination could facilitate learning and spread of innovation.’
Overall, if the government is to be serious about integrating care then they should tackle the opposing cultures, and funding systems, which encompass the two sectors and take the best approaches to improvement from both health and social care.
