How is health and social care integration being achieved in England?

Sharing data between health and social care bodies is fundamental if the objectives of the Better Care Fund are to be achieved as part of the broader ambition of integrating health and social care. However, to understand where, when, what and how data should be shared, it’s important to understand the policy and legislative context. In this article we look at the changes that have been introduced to help facilitate health and social care integration, including significant pieces of legislation such as the Health and Social Care Act and the Care Act.

Since coming to power in 2010, the coalition government has introduced a series of major reforms to health and social care. They argue that these reforms are necessary for meeting the future needs of patients, as well as providing a more efficient public health service.  Central to these changes is the idea of integration, where services are delivered in a way that limits duplication, delivers more preventative care and targets resources more effectively. However, what has the government done to facilitate integration between health and social care?

In 2012, the Health and Social Care Bill was given royal assent and became an Act. The Act introduced a number of key changes to the way that healthcare is delivered, including:

  • the merging of a numbers of quangos, such as the Health Protection Agency and the National Treatment Agency for Substance Misuse, into one national body, Public Health England (PHE);
  • the abolition of Primary Care Trusts (PCTs), and the introduction of Clinical Commissioning Groups (CCGs), which are GP led bodies responsible for the commissioning of local health services, as well as a greater responsibility for local authorities;
  • the extension of the remit of bodies, such as Health and Wellbeing Boards, giving them extra responsibilities, including the development of strategies across health and social care to meet local public health issues;
  • the introduction of a new organisation, Healthwatch England, an independent body set up to promote the interests of patients in health and social care services.

In 2013, the government introduced a new funding mechanism known as the ‘Better Care Fund (BCF)’. This was a £3.8 billion pool of money to support health and social care bodies through the process of integration. Health and Wellbeing Boards (HWBs) are expected to provide plans to access the funding. These plans are assessed using criteria that includes:

  • how well data is shared between health and social care bodies;
  • how well plans protects social care services;
  • how it protects seven day a week services;
  • how well it reduces admissions to hospitals at weekends.

According to the County Councils Network, plans will have to show how services will be delivered in an innovative way that meets the local needs of people over the long term, in order to ensure funding.

In 2014, the government introduced the Care Act, a piece of legislation based on the 2011 Dilnot report into the funding of adult social care. The Act has been described as the biggest transformation in the care system since 1948, and introduces a number of significant changes, including:

  • that those who receive care from a regulated care provider or local council will be covered by the Human Rights Act, although those paying for care are not covered;
  • introducing a new cap of £72,000 on the cost of care for those eligible under the Act;
  • introducing duties for local authorities to offer prevention services, including the right to receive accessible information and advice, to try and reduce the numbers of people needing to go into hospitals.

The current Minister of State for Care and Support, Norman Lamb MP, has stated that the government is committed to integrating health and social care by 2018. However, it will be very interesting to see if the health care system can be fully integrated by that deadline and whether it can deliver the sort of outcomes expected.

By Steven McGinty, Idox

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