Our recent article, Thinking Ahead, explored the impact of the implementation of the Dilnot Report. On the one hand, the report encouraged a greater fairness for people to be able to plan their finances with a greater sense of certainty that any care they should need in the future would cost a finite amount of money. On the other hand, it was felt that the funding reform would, over time, highlight the substantial disparity between the cost of self -funded care and the fees that Local Authorities are prepared to pay. So, now that integration between health and social care is at the forefront of the political agenda, we explore what impact this may have on fees and the delivery of appropriate care.

Integration is not new. The political rhetoric goes back as far as the 1970’s but has never really taken hold until now when we hear that projects will roll out up to 2015 with full integration in place by 2018. The national economic situation may be what is stimulating this but the NHS, with their apparently protected funding, may see this as a cut. After all, the £3.8bn NHS fund for health and social care integration means that about £10m will go out of each CCG’s budget to pay for it. On the other side of the fence, Local Authorities will see this as some comfort in cushioning the impact of their relentlessly reducing budgets. Nevertheless, integration means cohesive collaboration between the parties who will have to agree where the cuts will have to take place in the NHS to fund integration and how social care can help to reduce the collective financial burden.

The personalisation agenda is the key to this with personal budgets leading the policy.  This means the money is centred about people and since they live in the community, personalisation means that integration will have to extend far beyond the boundaries of health and social care to encompass charities, community groups, social enterprises and so on. Leadership from the centre will also need to extend far beyond the existing boundaries. The NHS is less practiced at this than social care so the learning curve is going to be quite steep if personalisation is to be effective in holding costs down. The bureaucratic obstacles will also need to be recognised and removed, sometimes requiring risk based judgements and brave decisions. Nurses in care homes for instance have enormous skills and understanding of caring for people with multiple conditions and have so much to offer acute services in helping to prevent admissions and support discharges but barriers stand in the way that will need to be overcome. The perception within the personalisation agenda is that residential care is the more expensive alternative to care at home but is this always the case when the cost of accommodation is added to the equation and we see such good outcomes for people. Breaking down the financial barriers between health, social care and housing could help to rebalance this.

Personal budgets also figure in the equation. They allow choice for people to decide where and how they receive care, meaning that block contracting systems will have to diminish over time as power moves away from the institutions. But the final twist in this complex chain of fundamental changes to the way in which we deliver health and social care rests with whether the right funding is put in place for people to effectively purchase the right care at the right quality to enhance their wellbeing, manage their conditions, maintain their independence (whether in a care home or at home) and avoid acute admissions as much as possible.

Julie Hopkins

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