6 Promoting integration of care and support with health services etc.
This clause places a duty on local authorities to carry out their care and support functions with the aim of integrating services with those provided by the NHS or other health-related services (for example, housing). This clause is intended to reflect the duty to be placed on clinical commissioning groups by section 14Z1 of the NHS Act 2006 (as amended by section 26 of the Health and Social Care Act 2012).
(1) A local authority must exercise its functions under this Part with a view to ensuring the integration of care and support provision with health provision and health-related provision where it considers that this would—
(a) promote the well-being of adults in its area with needs for care and support and the well-being of carers in its area,
(b) contribute to the prevention or delay of the development by adults in its area of needs for care and support or the development by carers in its area of needs for support, or
(c) improve the quality of care and support for adults, and of support for carers, provided in its area (including the outcomes that are achieved from such provision).
(2) “Care and support provision” means—
(a) provision to meet adults’ needs for care and support, and
(b) provision to meet carers’ needs for support.
(3) “Health provision” means provision of health services as part of the health service.
(4) “Health-related provision” means provision of services which may have an effect on the health of individuals but which are not—
(a) health services provided as part of the health service, or
(b) services provided in the exercise of social services functions (as defined by section 1A of the Local Authority Social Services Act 1970).
Not sure if the requirement in para 1 only applies to social care, would a requirement to consider integration if that improved health or reduced need for health provision be a useful addition?
I agree. We have a Health and Social Care Act- about the health service and now a care and support bill about social care – both urging collaboration but ducking the need to pool resources ( currently legally possible but unpopular with agencies). Elaborate and expensive processes are therefore required because the Law continues to demand integration and collaboration but not to enable it financially. So patients and service user still either fall through the gap or there is expensive duplication.
We have been talking about this for over 30 years but no government has really tackled iteffectively and this Bill won’t either..
In addition to pooling of resources there needs to be a sea change in the attitudes of many NHS staff and services. The different approach by the NHS and Social Care is obvious to anyone who uses both (s.users and carers). Until there is this understanding by the NHS of the social model of disability and an understanding of the day to day realities of Carers lives I cannot see how they could successfully merge. Anyone who has been a s.user or carers in Mental Health services will know that this is the most medical models of medical models of care. Why is it that when a person puts on a medical “uniform” (white coat/ blue uniform) they seem to lose touch with every day life? I’m sure I’m not alone in thinking this.
Barchester Healthcare would like to see a greater emphasis on collaboration between health and care services. We do not believe that the Nicholson Challenge can be delivered upon without substantial changes in the way that care is managed. In the context of services for older people the current system effectively encourages overuse of hospital beds: because they exist they are filled. But hospital admissions are no one’s first choice. They are widely acknowledged to be damaging for older people, particularly older people living with dementia, undermining independence and eroding choice and dignity. High quality care homes offer more homely environments, with a better quality of life and patient experience based on facilitating choice, retaining life skills and person centred care. A care home bed is half the price of a hospital bed. Under these circumstances care homes should take over a rehabilitative role based on commissioned outcomes; expensive hospital beds should be decommissioned. The question guidance on the Care and Support Bill needs to anticipate is why this has not happened in the past and what can be done to facilitate change and innovative developments for the future. In our view, a necessary foundation for effective collaboration is the involvement of providers in commissioning processes from their inception. Most tendering of services runs on narrowing tramlines, based on wanting more of the same for less. Involving providers in discussions before tenders are drawn up allows for innovation and more effective partnerships. Single commissioning across the health and care divide and arrangements allowing social care providers to collaborate with health partners under their complex new licensing arrangements should be considered; developments in these areas would strengthen the overall impact of the bill.
The ambiguity in this section offers little with which to foster partnership agreements, the ‘wavy line’ of the 1990 Community Care Act is fast becoming an undulating or meandering pathway. To avoid so called post code lotteries of health and social care, we simply need greater transparency of all assessments which have the potential to attract services, from Continuing Health Care Criteria to Blue Badge Applications.
what is the difference between care and support. care is the basic stuff to avoid people moving backwards in their wellbeing while support is works supports people to forward such as accessing education and employment
As with other clauses, the insertion of ‘social services’ after ‘local’ in the first line would be helpful.
No requirement to be part of groups promoting best practice, how is each LA in isolation going to know how well it is doing ? Still think care provision standards should be against national set standards in training and delivery. Still will result in postcode lottery as to quality of service provision.
This section does will not prevent the wranglings over whose responsibility it remains when social care and health overlap without defined criteria, pooled budgets and CHC sorted out. Will ‘health provision’ be defined beyond or include universal services.
WE have heard so much in the past about ‘seamless services’ and ‘joined up services’ but they have seldom happened – now is the opportunity to weld them all together to create a situation where that is what we achieve – with a clear set of national standards to do away with the postcode lottery. Perhaps we need to remove this funding and function from the LA’s etc and set up a national body encompassing Health and Social services (rather more like probation) whhich may achieve this goal.
Integration with Health is essential if health and social care moves to meet the health and social care needs of the 21st C. Health affects social care and vica versa. To create an inproved efficent service it is an integrated part of sucess. CCG’s have to look at this
In my area, my GP practice is in a CCG where we (my community) are not in the same Borough as all the other practices. On the new CCG website – there is no mention of the demographics of my community – no mention that the CCG serves us within a different Borough – the CCG is even named after the “other” Borough.
I feel very worried that we will be going the same way as before when we were plucked out of our “natural community care planning environment” in the PCG which merged to a PCT before Surrey merged them all into one. I fear that any service planning will not include my Borough Council or the voluntary organisations that are based in the only town in my Borough – just as before. Will services we need locally be funded by those who have no interest in my community? I think not. I feel disenfranchised by this.In time we will do the whole merry go round thing again and they will all have to merge once more when they prove to be non-viable. Except – This time it will have cost a few £billion to do so. An expensive ride?
How could further integration NOT be good for people’s well-being, I find myself asking – or NOT integrating, ever be better for it? Legally, the most this clause does, in my view, is to make people’s well-being through integration, as opposed to operating distinctly, a relevant consideration in the organisation’s approach to its functions, and it is difficult to see how that aim, or value, could ever NOT be regarded as implicitly, self-evidently relevant to the over-arching procurement and provision duty to promote the improvement of the comprehensiveness of the whole social support/care/health continuum…
I see no mention of mental health care as per usual?
This is one of the most disadvantaged groups, no matter where these folk go, NHS services treat them as second class citizens, a nuisance, ‘difficult folk’ etc.
some service providers are now so big that patient choice has been removed … unless you want to travel a few hundred miles!
Patient choice should include the mentally ill who often have no choice it all, a ‘take it or leave it’ approach often causing them to fall by the wayside.
How many of these consultations include mental health … none as far as i can see!
In addition to the above – MH service users and carers have been mislead for decades! Where a person is not eligible for a secondary MH service but has social care needs they still have a right to a community care assessment via the local adult social care team( ie not via the CPA) and if they have an eligible need their access to support is via the community care team. Ditto for Carers and access to support via the local ASC team. Most MH s.users and carers have only been told about secondary services and the CPA route. This is discrimination in social care to add to the proven discrimination in health care. This Bill will apply to all (inclusive of MH s.users and carers) and since the MH strategy implementation framework of No Health Without MH – this social care discrimination should now end. As a Carer who has fought for this to recognised and put right for the last 17 years I urge all MH s.users and Carers to demand their equal rights.
Nice words but I see very few teeth to actually make it happen. Are we relying on the Health and Well Being Boards to achieve this. I fear this may not be sufficient.
Integrating health and social services is ok, as long as it is recognised as a nursing need when it has gone beyond the realms of social services, otherwise it could lead to suffering for the patient. So the line needs to be clearly defined between nursing needs ie pain relief nutrition etc. and social care. Otherwise all the problems are still going to exist.
I would like to see reference somewhere in this clause to housing – provided both by councils and Registered Providers (aka housing associations/RSLS). Housing is integral to well-being; the focus should not be just about integration of health and social services. And housing staff provide ‘support’ – that is not just provided by health and social services.
I am in the process of responding to a Clinical Commission Group who has £130.000000 but no mention of the inpact of Social Services or their involvement in this latest project of the Government. An integrated system of Health and Social Services is the only way forward, it will require more GP training, and Publicity in the public arena if we are going to make a difference. GP are in the front line, they must be more proactive in their patients Social needs. Too many patients are suffering Socially due to lack of care.
Transition is a major aspect of a young disabled person’s life (and a huge, long term and complicating worry for their parents), so the integration of services to support young people into adulthood must oblige to social services to involve the young person’s school and teachers in care and support planning from at least the age of 14.
We strongly welcome this requirement for co-operation between NHS and social care services. Data in our area suggests that significant NHS resources are used providing care to people who have been admitted to hospital, recovered so they are fit for discharge but who do not have in place the support they need to return home.
At our public events, a number of older people have told us that they would value an opportunity to discuss their care aspirations with their local authority before they are eligible for formal support services. We wonder if doing this would enable people to be discharged from NHS facilities more quickly.
We welcome the promotion of integration and believe it should also include recognition and involvement of local voluntary and community services, which also play a major part in improving wellbeing. It remains unclear how care and support can be further integrated with health when there is such a different eligibility and funding basis; where some people are self-funders of social care and may opt out, while others in need of social care are funded.
The definition of social care in relation to nursing care has steadily been shifting and remains variable across the country. In some services such as mental health, adults are eligible for on-going NHS support but not for local authority care and support.
We would welcome increased engagement of Clinical Commissioning Groups and feel there is a need for increased training about care and support systems among GPs.
West Anglia Crossroads strongly supports the need for integration of health, mental health and social care services. One of the barriers is the “free at the point of provision” in health and the introduction of FACS charges on transfer to social care.
The difficulties in integrating dont appear to have solutions here. Making the responsibility a shared one or with health might make change more likely.
A ‘Duty of Care’ applies and such wording should be included.
6. (1) provides a good example:-
A local authority must exercise its function ‘WITH A VIEW TO ENSURING’……..
the words ‘with a view to ensuring’ should be replaced by ‘under a duty of care to ensure
Admiral Nursing fits so nicely in this area as often Admiral Nurses provide a bridge between health and social care. Integrated care is more joined up, holistic, and coordinated — it can keep people at home longer and avoid costly trips to hospital and deter entry into long-term care. It makes economic sense — but more than that, it helps people live well at home with a better quality of life — for both the carer and the person with dementia. I guess my comment here is that the local authority will need to ensure adequate resources are made available so such services (like ANs) can continue and thrive.
People with dementia and their carers continue to ‘fall through the net’ with insufficient social care provision and often poor access to health services as the debate continues about which service they fall under. As Jenny Weinstein says this has been talked about for the last 30 years. With the present cut back in funding I am not hopeful that success will be achieved now.
We are a small charity devoted to the idea that people with dementia should be able to stay in their own homes and die there whenever possible. We are now turning to the concept of ‘compassionate communities’ and the large scale use of well trained and supported volunteers to allow this to happen.
Where is there any mention of Carers rights at the point of Hospital Discharge in this Bill? This is renowned for being a critical time for Carers when the people they care for are often discharged with little attempt to ensure that the Carers is able or willing to undertake a caring role; has the support to do so; has the skills to do so. A carers employment is a critical issue at this time yet, so often, ward staff just expect Carers to step in at short notice. They can’t just leave their jobs in order to provide care for a relative so why do they think we can?
Also I didn’t see anything about NHS funded Continuing Health Care in this Bill. This too has a serious impact on Carers. There is muddle in the existing guidance about who funds the support for the Carer. A NHS care package must be sufficient to support the Carer through services to the patient (when that support is personal care to the patient) – this cannot be a Carers service – but we find that the NHS will not provide sufficient care. The rules say that this care cannot “be topped up” by the family (only with another care provider which can be unacceptable – too many different people) . Social Care can only provide a service to the Carer. This is often seen as a break yet a working Carer needs more than a short term break – they need an ongoing regular support system to enable them to continue working. This needs to be sorted out yet there is nothing I can see in this Bill to resolve existing muddles.
At every NHS/ Social Care interface there can be problems – Under current arrangements there must be clear care pathways – but often they are unclear – including discharge from metal health secondary care These need to be re-inforced, clarified and attention given to developing and using Carers Care Pathways at every NHS/ social care/community interface.
HOUSING:
The White Paper is notable in that it makes several and specific reference to housing as a vital component in supporting and improving people’s health and care outcomes.
Housing has never been given such recognition in a care context before, so JRF welcomes this progression in thinking. Nonetheless, given the prominent place housing has in this White Paper, I was surprised to see that housing was almost entirely absent from the chapter related to “integration”, with only one brief mention. The integration chapter is narrowly focused on the integration of health and care, with details of various models being developed to facilitate this, while housing is removed to a separate chapter. We hope that housing will remain part of wider integration plans and that the three services vital to the wellbeing of older and disabled people will be developed and brought together in a much more integrated way where feasible.
The duty on local authorities to ensure social care and housing departments work together will begin to bring housing into the fold, after years of being overlooked by their care and health counterparts. Of course, this does not guarantee that non-statutory housing partners (e.g. housing associations and social landlords) will gain the access to social care and health commissioners necessary to meet their clients’ needs. Housing providers remain, for example, an optional partner on Health and Wellbeing Boards so could well be excluded from these forums in some areas.
Capital funding to encourage such providers to develop new accommodation options for older people and disabled adults is also very welcome, as the market is not meeting demand on its own without this extra stimulus. The findings of the HAPPI report , published in January 2010, give a clear picture of what can and has been achieved in other countries in terms of innovative and cost effective ways of building sustainable and inclusive homes and communities for an ageing population. We also are glad to see the extra care model floated as a cost effective alternative to residential care that might be invested in, however further work may need to be carried out to identify the most cost effective models of this provision and who best it suits (Callaghan, Netten and Darton 2009, Croucher and Bevan 2010).
Note: References to JRF research available via http://www.jrf.org.uk
I will re-iterate that if Health was the responsible authority there would be no need for integration.
To meet the increasingly complex needs of service users and carers it is essential that the work of health and social care professionals is integrated. The process should be developed in a spirit of trust, equality and mutual understanding of roles.
There is evidence that interprofessional education, where participants learn from, with and about one another, can result in effective integration and collaboration.
Education and training for collaboration and cooperation / working in this different way is essential. Failures of services in care and support have often been due in part to lack of understanding of roles and responsibilities / lack of trust and poor communication.