Integrating wellness and social services is no promise of savings | @guardianletters

‘The extremely elderly come in to hospital generally as a outcome of a fall, or getting to be abruptly confused or significantly less mobile.’ Photograph: Garry Weaser

I am unsurprised that the Cabinet Office overview (Whitehall calls halt on £3.8bn NHS reforms, 7 May possibly) found that strategies to integrate health and social care services showed little prospect of generating financial savings. It is not the separation of these two companies which is the underlying result in of overuse of hospital care by the frail elderly it is the much more basic issue of care being free of charge in the NHS but indicates-tested for social providers. This can lead right to an extended length of stay in hospital while detailed assessments are carried out to make a decision who will be responsible for paying for the care required on discharge.

Shortening the length of stay is the place the main savings for hospitals can be produced. Enhanced local community providers have only a limited role to play in decreasing admissions in the very first location, as practically all admissions are the direct end result of both new or worsened medical circumstances. The quite elderly come in to hospital frequently as a end result of a fall, or getting to be out of the blue confused or much less mobile. Even though the 1st of these sounds amenable to greater social and local community care, in practice this prevents reasonably few falls as most are due to medical issues. These need diagnosis and remedy, and the elderly need to not be discriminated towards by becoming denied this just simply because they are elderly. The underlying diagnoses are many and different, and frequently demand the services of an acute hospital.

Even though the funding techniques for wellness and social companies continue to be so disparate, individuals who wish to find financial savings in the hospital sector would do better to emphasis on speeding sufferers across the boundary amongst the two, rather than integrating them.
Dr David Maisey
Retired consultant geriatrician, Norwich

• Contrary to your reports, far from halting the Far better Care programme, we have produced great progress on a venture that heralds a historic merger between health and social care commissioning.

The schemes in each and every spot start from April 2015, but we asked for early drafts to be ready a yr early so we had time to make sure they provide the genuine advantages for individuals envisaged when the scheme was set up. That is what is occurring, and the consequence is an interesting collaboration which has observed neighborhood government and local NHS commissioners operating collectively in a way that has by no means took place just before.

As your editorial states, the Greater Care Fund is “crucial to the prolonged-term viability of the NHS”. Mixed with the announcement by Simon Stevens last week that clinical commissioning groups will be invited to commission main care jointly with NHS England, we have for the first time the prospect of a single organisation leading the commissioning for all out-of-hospital care, a significant step forward in the integration of care that has often been talked about but in no way in fact delivered. No doubt the road to acquiring there will be bumpy, but it is a vital phase in the revolution in out-of-hospital care we require if the NHS is to carry on to meet the growing aspirations of an ageing population.
Jeremy Hunt MP
Secretary of state for overall health
Eric Pickles MP
Secretary of state for communities and
local government

• Your write-up appeared to suggest that the fund was unravelling. Clearly, trying to draw two extremely various providers collectively – the NHS and regional government – to integrate in a way that ends an institutional obsession with acute provision in hospitals as a implies to offer care, the BCF is not the only way of repairing the program, but it is the best way to guarantee all places benefit from integration amongst the NHS and Nearby Government. 

In Staffordshire, we have previously established a partnership trust with our nearby NHS to bring collectively solutions from each the county council and acute sector into one particular automobile that breaks down silos, avoids duplication and provides a vehicle to deliver a much better services locally. We did this without having a Far better Care Fund.

The actuality is that in Staffordshire, and in several other nearby places we are already integrated, but only as far as current resources permit. The BCF is the next stage, a means of investing in prevention and community care to cease the horrendous unsustainable burden placed on acute solutions inside of the well being service. Integration, the BCF and closer functioning with the NHS are vital basically since of the long shadow cast by the Francis report. Better integration is portion of the lesson we all have to discover from the Francis report in Mid-Staffordshire.
Philip Atkins
Leader, Staffordshire county council

• The push-back on the Greater Care Fund by Numbers 10 and eleven is but one more illustration of short-term political consideration blocking a critical try at rebalancing overall health and social care. Anyone with any grasp of health organizing understands there has to be front-loading to get new local community services functioning prior to any financial savings will be delivered at the hospital finish (the transitional funding stressed by David Nicholson). It did not occur with the closure of the psychological hospitals in the 1970s and 80s or with the Community Care Act in the 1990s. When New Labour had the cash and the neighborhood structures in spot to do it (coterminous and potentially co-operative principal care trusts and regional authorities) political fixation with hospital targets squandered the opportunity.

Lansley’s reforms have been always going to make the collaboration more hard. Pre-election panic in excess of hospital balance sheets yet yet again scuppers wise approach. How differently factors may have gone if Norman Lamb had acquired Lansley’s publish in 2010. Kate Barker’s interim report for the King’s Fund demonstrates extremely obviously that the Greater Care Fund was heading in the right direction but that the politicians are by no means going to provide if they cannot be sincere about the price. Her group is consulting on funding but also on how best to harmonise commissioning at national and nearby level. A single can only hope that the up coming government requires far better note than Gordon Brown did of her recommendations on residence-building.
Colin Godber
Winchester, Hampshire

 • Lambeth (and no doubt other authorities) have place in spot innovative programs for the demolition and promote-off of perfectly excellent and nicely-loved (if ill-maintained) sheltered housing schemes, constructed in the halcyon days of the reknowned Ted Hollamby. This has grow to be a indicates for nearby authorities to shuffle off obligation for their elderly tenants, bringing in “private providers” and medicalising outdated age.

Hundreds of the frail and elderly, whose tenancies are exempt from correct-to-buy, are currently being subjected to anxiousness and uncertainty with the threat that they will be moved to unknown destinations, away from close friends and loved ones members and their minor help networks broken up. An example of the “large society” in action.

Will the Cabinet Workplace suggestions to government that the claims of the Much better Care Fund do not stack up put a stop to this excoriating cruelty currently being visited on the elderly?

Allow us hope so.
Kate Macintosh
Winchester, Hampshire

Integrating wellness and social services is no promise of savings | @guardianletters