Health and social care integration is risky for NHS services

Health and social care integration is risky for NHS services


The chancellor's spending review outlined plans to increase funding for the health and social care integration fund from £0.9bn to £3.8bn, with at least £1bn being linked to reducing emergency admissions. However, this is not new money but a shift in funds from core health services to the integration pool (a planned shift of £3bn from the 2015‑16 NHS budget). Also, it does not take into account rising costs within the NHS, new drugs and treatments that are being approved by the National Institute for Health and Care Excellence (Nice) and multiple co-morbidities in an ageing population. So, in real terms, we are likely to see significant impact on patient care and the health service's ability to manage rising patient demand and expectations. It hasn't been made clear whether the NHS will actually be able to spend what has been allocated to it or is expected to make unrealistic efficiency savings, with the intention of meeting the Nicholson challenge of saving £20bn by 2015.



As a GP, I welcome the rationale behind the joined-up approach of health and social care commissioning. In previous years we have seen significant cuts in social care funding that, in turn, have stretched our primary and secondary care services to the limit, and led to the A&E crisis that we see today. Better social care will help to cut emergency attendances and admissions, but it will not address the burden of disease in an ageing population. Primary care has seen no rise in the number of GPs over recent years, while there has been an increase in the number of consultants.


Primary care budgets have also seen a drop, while more work has been passed into the community; 90% of patient contacts are in general practice, which is allocated just 9% of the NHS budget. Though the core NHS budget is said to be ring fenced, there is the danger that cash-strapped social services could potentially absorb more crucial funds. Pooling of funds is risky, with NHS services likely to lose out. For instance, new immunisation schedules are being rolled out all the time, as well as the use of new, expensive drugs used for cancer treatments. If there is no extra money for this, existing services such as hospital beds would be cut and there could be a reduction in GP numbers as practices limit recruitment.


It costs the NHS about £100 every time someone attends A&E. GP visits are much cheaper than hospital attendances, whether in an emergency, for clinics or tests. It would be more cost-efficient for GPs to manage more work, but they need the resources to do this in terms of backup of specialist advice (easy access to consultants in the community) and increased funds to allow them to employ more GPs and nurses (thereby increasing consultation time with patients). There are other soft targets in the NHS. Administration budgets have seen legitimate cuts over the years but are being reduced further by 10%. If commissioning groups are to function efficiently they will need to maintain their management structure, which is threatened by these cuts.


While the hospital and A&E crisis is widely recognised, there is little acknowledgment of the turmoil within general practice. A recent Royal College of GPs poll found that almost half of GPs felt that they could not guarantee safe patient care. This is worrying, especially when we are told that this is just the tip of the iceberg, with more responsibilities being shifted into the community. The government is taking a gamble in thinking that social care alone will tackle the huge burden of disease in our country. It also needs to commit to putting forward realistic and protected budgets specifically for hospitals and primary care.





By Zara Aziz,


The Guardian, 10th July 2013




View this article