This week sees the largest gathering of those responsible for adult social care: the National Children and Adult Services Conference in Eastbourne. The biggest theme has been the enormous potential gains from the "integration of health and social care".
New minister Norman Lamb made it clear that this is a priority, and it has also been mentioned by countless others. There is even a session at the event entitled ‘Oh No, Not Integrated Care Again'.
However, I would like to propose that the obsession with structural integration is at best a sideshow, at worst a distraction from the real issues. A ground-breaking new study Home Truths from iMPOWER unearthed the real issue: the dysfunctional relationships that exist between health and adult social care staff.
We decided to focus in on the highest spend area of the adult social care budget, residential care. Costing approximately £5 billion per year, residential care has rightly been identified as an area where significant savings could be achieved – not least because the evidence shows that older people prefer to remain independent.
Our research found that there are many older people in residential care who don't need to be there. The Directors of Adult Social Care who we spoke to estimated that between 30 and 60 per cent enter residential care too early, and 57 per cent of social workers agreed. Eighty two per cent of the GPs we surveyed believed that a large proportion of older people could delay or even avoid entry into residential care, if better support was available to them.
However, our research also uncovered some surprising "home truths" about what is actually driving demand for residential care: the dysfunctional relationships between GPs and social care staff. Over half of GPs admit that they don't understand what alternative care options are available, with only 15 per cent agreeing that they do understand all of the options.
GPs act as strong advocates of residential care for older people – and this is a problem because our research revealed that GPs have enormous influence over older people's decision to enter residential care – as great an influence as their own family and more than twice that of social workers.
We are not saying that this is all GPs' fault. Councils have made almost no effort to influence the behaviour of GPs in relation to this issue. All the Directors of Adult Social Care who we spoke to "strongly agreed" that not enough time and effort has been put into understanding doctors' views about care, and only 26 per cent of the GPs we spoke to thought that social care staff and councils have helped them to understand social care options.
We believe this shows that a completely new starting point for health and social care integration is needed. iMPOWER agrees with councils that changing the interface between health and social care is a big part of the solution to the funding crisis. However, we believe that massive wasted effort is going into chasing the "fool's gold" of structural and process integration. Instead, councils should be focusing on the hearts and minds of individual staff – targeted individual relationships – in order to build behavioural insight, and use this insight to reduce demand for services.
This is not a fluffy call for a ‘new relationship' between councils and the NHS. Indeed, our research showed the real savings that can be realised through this approach. We calculated that over 60,000 older people could avoid going into residential care every year, with a saving of £600 million – or £4 million per council on average – by influencing just 52 GPs in every local authority area. The potential is clear: applied across a wider set of relationships, the savings could run to £billions.
In conclusion, our research points to real solutions among the funding crisis doom and gloom – but also reveals that current attempts at structural solutions are misguided. Indeed, I suggest that we ban the term "integration" until we are all clear that it is in fact the behavioural integration of individual people working within health and social care that will unlock the real change.
To download a copy of the Home Truths white paper, please click here.
