Moves to integrate health and care services have so far been undermined by a focus on short-term challenges rather than a long-term approach based on preventing ill health, national auditors warn.
A new report on integrated care systems (ICSs) by the National Audit Office (NAO) found that ICSs have been ‘broadly welcomed’, but it said that service and financial pressures on the NHS and care providers prevented them from focusing on local priorities.
NHS England have tasked ICSs to take a long-term approach to health by focusing on prevention. However, the NAO found that the targets it has so far set for ICSs are about short-term improvements such as financial management and tackling elective care backlogs.
NHS England has allocated £97m across all 42 ICSs for efforts to improve prevention and an additional £200m for tackling health inequalities, compared with £2bn to tackle elective care backlogs.
The NAO’s report also noted that there had been ‘little progress’ on establishing a structured approach to addressing the wider factors that affect health outcomes, such as healthy behaviours, social and economic reasons, and the physical environment.
Gareth Davies, head of the NAO, said: ‘The new model of integrated health and social care services is being implemented with broad support, but at a time of extreme pressure on both services.
‘To maximise the chances of success for these new arrangements, DHSC [Department of Health and Social Care] and NHS England need to put realistic medium-term objectives in place. They must also tackle pressures on ICSs that require action at a national level, including workforce shortages in health and social care.’
Commenting on the report, Cllr David Fothergill, chairman of the Local Government Association’s (LGA) Community Wellbeing Board said: ‘The LGA supports the introduction of ICSs but we also share the concerns raised in this report, which rightly highlights the risk that the long-term aims of ICSs to prevent ill-health are being overshadowed because of a national focus from the Department for Health and Social Care and NHS England on short-term priorities such as elective care recovery.
‘Developing a structured approach at national, regional and local levels to address the wider determinants of health is key to improving the health of our communities, and we strongly support the NAO recommendations that DHSC and DLUHC works across government to address issues such as education, employment, benefits and transport as part of their approach.
‘Councils and Health and Wellbeing Boards must be at the heart of this revised approach as the community leaders and drivers of many of these services.’
A Department of Health and Social Care spokesperson said: ‘A more joined-up health and care system can help thousands more people get the care they need at a local level, in the right place at the right time.
‘Integrated care systems remove barriers to joint-working, support innovative local solutions and give local leaders more freedom to rapidly fix the issues that matter most to patients, delivering on our ABCD priorities – ambulances, backlogs, care, doctors and dentists.’
