JimKenLast year, the Labour Party invited Sir John Oldham to form the Independent Commission on Whole-Person Care, which was asked to make recommendations about how health and care services in England could be integrated, within existing resources, and without another reorganisation. So what is the direction set in his report – One Person, One Team, One System - asks CareKnowledge editor Jim Kennedy?

I think there is a need for a slight chorus of ‘here we go’ as a first comment on this report. By that I mean by it marks a bit of a start to what is likely to be a prolonged period of debate on this subject in the run-up to the next election, as all the major parties begin to put together their particular solutions to that thorniest of problems – paying for social care.

Additionally, all parties may be considering the role and importance of social care and health integration, especially given the background of budget shortfalls and cuts to resources. This of course begs the question of whether such integration could, in the short term at least, offset any cutbacks?

I’m sorry to link the Whole-Person Care report so firmly to the economic arguments rather than the more effective services and better outcomes that might flow from greater integration, but I think those arguments are the real drivers for change, and it is helpful to recognise that. In tough times we will all benefit if better ways of delivering care can be found, including the pooling resources – and it is through such routes that service improvements might come.

But in resource-constrained times, integration (in whatever form) will be a way of securing smaller-scale benefits, than if a growing system was embracing such approaches.

The lack of decision-making about the funding of social care is the biggest dereliction of policy duty in modern times. It has resulted in a situation where we return to the same debates repeatedly, while politicians attempt to make the same arguments seem new and any solutions appear innovative.

There is a danger that the more recent but now, increasingly long-in-the tooth debate about what integration can contribute to better (more efficient) care will enter the same spin-cycle, to be constantly hauled out of the machine, tidied-up and dried a bit, before being completely washed through again.

As I’ve already noted, any real movement on integration will have to wait until after the next election. But, even leaving that certainty aside, the Oldham report simply makes recommendations on which others will have to act. It can’t make decisions. And, some of the recommendations in the report are effectively to spend more time thinking about these issues after the next election, in any event.

What is clear from the report’s recommendations is that there is no rush for re-organisation as a means of delivering better integration. Instead there is – as implied by the title – a push for the system to treat individuals, and their needs, as a whole; and for that to be achieved through joint approaches to commissioning, and pooling of budgets.
The report’s recommendations also emphasise the need for any new system of integration to allow for local flexibility, with different models built around local need and preference; with a lead role for health and wellbeing boards; and with all of the approach built on the achievement of patient/user outcomes, rather than service targets.

Other more detailed recommendations include that there should be a single identifiable person to act as care coordinator for people with complex needs; that multi-professional working should become the norm; and that individual health and social care records should belong to the person concerned. 

There’s a lot in the recommendation that, if acted on, would lead to better integration. And, to be fair, there are a lot of what I’ll call secondary mechanisms that are recommended to support those pursuing more effective integration, but there remains a risk that the good arguments for doing  more will run into the sand, without some real steam behind them.

That’s a particular issue in a field where critics will say we’ve known about the opportunities and benefits of joint-working and commissioning for a long time, but the patient/carer experience is still not always one of seamless services.     

However, for the last part of this blog, I want to return to the point I made earlier about this being a report that effectively recommends further consideration of ideas in some areas, rather than putting forward final solutions. Here’s the specific recommendation that particularly re-enforced that feeling:

“We recommend the commissioning of an Independent National Conversation backed by all major political parties to define a consensus on the scope of services provided by, and the future funding of, health and social care as a single issue. This should report within 12 months of a new government being formed, to enable its agreed proposals to be enacted from 2020 onwards.”