The Guardian view on NHS funding: integrating hospital and community care is right, but it won’t save money
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Version 0 of 1. As more details emerge about the crisis in the quality of care at Colchester general hospital, a new and authoritative report warns that whatever the failings in one Essex hospital trust, the whole of the NHS is heading for trouble. Less than a week after the health secretary, Jeremy Hunt, promised another £300m to ease pressure on A&E services – hoping to stave off a winter crisis in the runup to next May’s general election – today’s report argues that no politician of any major party has begun to address the reality of the funding gap precipitated by rising demand and declining resources. It describes the pledge by the new NHS England boss, Simon Stevens, to make efficiency savings of close to £100bn over the five years from 2015 as “heroic”, warns that there is no evidence from any other healthcare system that integrating hospital and community services will produce short-term savings, and questions whether even in the medium term they would be on the scale predicted. In order to reduce pressure on emergency admissions and to shorten hospital stays, the move to join up services – mainly for elderly people, who are driving demand – is now at the heart of every political plan for the health service. The coalition has the Better Care Fund, which is required to generate £1bn of savings in the coming financial year. That relies on a whole new structure of integrated care packages being rolled out on a large scale in a matter of months. Labour’s ambition is even more expansive, although Andy Burnham, the shadow health secretary, recognises that it should be allowed to evolve. Yet even he betrays signs of the besetting weakness of NHS policy planners: an optimistic faith in the one-club solution, regardless of the lack of supporting evidence from anywhere else in the world. Yet caring for frail elderly people is now the core business of most hospitals. Imagine a commercial enterprise that regarded its principal customers as an awkward inconvenience. Instead – as the report, commissioned by the Health Service Journal, argues – hospitals should recognise that the best community and intermediate care in the world can never keep elderly people out of hospital all the time. The kind of indifferent care that too many patients’ families report is the direct result of hospitals treating their relatives as a problem rather than trying to make that unavoidable stay as good as possible. Hospital care that fails to recognise the specific needs of geriatric patients causes more long-term problems, strikingly illustrated by the statistic that 10 days in a hospital bed leads to 10% loss of muscle mass. This is not the first serious challenge to the received wisdom about the financial benefits of integrated care. Only last week the National Audit Office warned that the Better Care Fund will not generate more than a third of the projected £1bn of savings. It might shift perspectives to recognise that the fact there are more old people is actually a mark of NHS success – and that, while not perfect, it is the most cost-effective way of delivering healthcare. So it deserves an honest debate about what it will take to keep it that way. |