Commissioning joined-up services

Care UK's Chief Executive, Mike Parish discusses the integration of health and social care for the benefit of patients and service users.

One of the main issues that currently seems to be concerning both PCT and Local Authority commissioners is how to organise better integration of health and social care, with the focus on positive outcomes.

The structural divide between health and social care is clearly unhelpful in providing complete and integrated services. There are many individual examples of excellent joint commissioning and the Care Trusts that have become established report significant improvement in services. But are there too few?

The law of unintended consequences seems to apply. The merits of local democratic responsibility (social services) and national cohesion and consistency (the NHS) each have validity, but the result can be a barrier to integrated care service provision.

Inevitably, this extends beyond organisational to financial and cultural issues.

Financial complications can include the frustrating “why should I spend my budget when it’s your budget that benefits” to the complication that social care is means tested, health care isn’t.

Cultural differences are inevitable after many decades of responding to organisations with such different drivers – whether local and national politicians or medically and socially led mindsets.

However, the benefit to patients and service users of effectively integrated services is too great and important to allow any gap to perpetuate. And, actually, the gap can be over-stated. In our experience, working with both health and social care commissioners, there is considerable common ground and expertise is quite complementary.

Reorganisation of PCTs to be coterminous with Local Authorities would be helpful, and would, hopefully, lead to more joint commissioning of services. Organising services across full care pathways can enable better focus on outcomes.

For example, in our own treatment centre in Barlborough Links we are responsible for home assessments ahead of admission for orthopaedic surgery, transport to and from the centre and post operative rehabilitation that continues in patients’ own homes. As part of this we supply and install any necessary equipment into patients’ homes. We also provide for intermediate care in the exceptional cases where this is required.

It is our strong belief that such service continuity results in a better experience for patients and for better rehabilitation and outcomes.

Perhaps stronger linkage between coterminous PCTs and Local Authorities can be a prelude to an evolution of more formalised joint budgets and commissioning. If organised well, this could be an opportunity to turn the aspiration of joined up services into a much more wide ranging reality.