National Audit Office says governance issues remain to be settled – and join other factors in the way of achieving integration
A reticence around information sharing is one of the factors holding back the integration of health and social care, the National Audit Office (NAO) has said.
Central government’s auditor has highlighted the issue as one of those that is placing at risk the plan for integration of care across England by 2020.
Its newly published report on the issue points to problems with information sharing as one of three main barriers, along with misaligned financial incentives and “workforce challenges”.
While this is connected to the drive for digital interoperability – one of the seven domains in the draft integration standard that underpins the campaign – the report says the problems derive largely from confusion over the regulatory framework, and insufficient support from the centre on information governance issues.
Although there have been no policy constraints on information sharing, the Department of Health (DoH) acknowledged to the NAO that it had not done enough to explain the rules around information governance. Subsequently it commissioned a further report from the national data guardian.
The NAO says it found from its case study visits that local bodies were still unsure of the legal situation on data sharing and that this was acting as a barrier. In turn, this has been making it difficult for them to track patients through care settings, compare costs and establish whether the integration that has taken place has saved money.
While the DoH and Department for Communities and Local Government have identified these barriers, they are not systematically attempting to remove them.
In addition, almost a third of the areas reporting to the NAO said they were still not using the NHS number as the main way of identifying patients, although this may be removed as a requirement as information sharing is covered by the local digital roadmaps initiative.
In a report that focuses heavily on the strategic and financial elements of the integration, the NAO says the Better Care Fund – the principle integration initiative – has improved joint working but has not yet achieved its potential or provided value for money.
Another problem has been that local government was not involved in the design and development of the NHS led sustainability and transformation planning programme, and that this has made it more difficult to align the efforts of the two sectors.
Lack of evidence
The NAO also comes to a broad conclusion that goes against the rationale for integration – that so far there is no compelling evidence that it will lead to sustainable savings or help to reduce the acute care strain in hospitals. It reiterates its call from its 2014 report on the Better Care Fund that there is a need for robust evidence on how best to improve care and save money through integration.
Amyas Morse (pictured), head of the National Audit Office, said: “Integrating the health and social care sectors is a significant challenge in normal times, let alone times when both sectors are under such severe pressure. So far, benefits have fallen far short of plans, despite much effort. It will be important to learn from the over-optimism of such plans when implementing the much larger NHS sustainability and transformation plans.
“The departments do not yet have the evidence to show that they can deliver their commitment to integrated services by 2020, at the same time as meeting existing pressures on the health and social care systems.”
Image from NAO