The need for a solution
The Stockport Labour Group supports efforts to end the fragmented way that care is provided to and initiatives to improve services for patients and the NHS, carers and service users. As such, we acknowledge the need for a contractual basis for the new relationships between partners, providers, and commissioners to underpin the process of integration between services, and therefore believe plans for Integrated Care Provider (ICP) contracts to be drawn up are both welcome and necessary.
The need for assurance
As part of this process, there needs to be provisions and assurances built in which can provide all partner organisations and the public with the confidence they need to back and fully buy in to ICP implementation. It is our view that if this is not achieved, the ICP contracts will could face significant opposition from the public, elected representatives and partner organisations (and, should these provisions not be sufficient, this Group). Without this, the ICP contracts process risks wasting public money across a range of initiatives which may end up being abandoned altogether or only be implemented nationally in a piecemeal fashion; suboptimal to achieving the overall policy aims of health and social care integration, and therefore suboptimal in terms of clinical outcomes for service users.
In order to avoid this, it is the view of the Stockport Labour Group that ICP implementation should be guided by the following principles:
No opportunity for Privatisation, and being seen as such.
Integrated Care organisations cannot and must not be designed to provide opportunity for privatisation, either during their implementation or later on via opportunities for ‘creeping’ privatisation. In particular, there should be protections built in to prevent the artificial classification of National Health services under ‘Social Care’. Further to this, protections and provisions against this must be robust and explicit enough that ICPs are seen to be a protection against privatisation, rather than a backdoor to it.
Democratic Accountability
In order to assure the public and provide accountability for the above, we believe that ICP’s should maintain and expand greater local democratic control and accountability in relation to Health and Social Care provision. Currently, there is a clear democratic deficit in this area in relation to the NHS in particular, where the link in with democratic accountability lags significantly behind the relationship between Social Care provision and Council representation. This could take the form of in built-provisions for democratically accountable representatives to uptake roles in the commissioning of services, and managing commissioner- provider relationships at decision-making level; allowing for scrutiny of those decisions and for democratic accountability with a directly accountable link to the public.
Not a defunding backdoor
ICPs must not provide a backdoor to defunding the NHS or Social Care, and must be seen not to. Whereas ICP’s and Health and Social Care integration more generally offer up significant opportunities for achieving saving through the elimination of duplication, economies of scale and demand management – any such savings should be reinvested in services. This should be accompanied by adequate Government resourcing in accordance with need (see the following point). The above points are essential to gain the backing of the general public, but also in terms of having buy-in from Council representatives. In our view, one mechanism to achieve surety in this area could be to build into ICP design guarantees over levels of transparency, linking with and complementing the aforementioned improvements in democratic accountability.
Adequate and sustainable funding
Crucially, none of the above can take place independent of an adequate and sustainable funding solution to be found for Adult Social Care provision. This mechanism should be based upon the distribution of resources in accordance with need, access to care free at the point of need, and work towards the elimination of charging within the system. This must take place alongside, rather than at the expense of adequate and sustainable funding for the National Health Service. More close to home, the lack of such provision risks serious implications for the financial situation of (and other functions of) Local Authorities, given that fact that Adult Social Care is the largest budgetary area for the vast majority of Councils.
Health and Social Care should not be treated as separate in terms of policy, nor funding as they are intrinsically linked in terms of demand. All health provision must remain free at the point of need, and should not be permitted to become artificially categorised as ‘social care’.
For further expansion upon these points, we refer you to our consultation response to the LGA Green Paper ‘the lives we want to lead’ available here: http://stockportlabour.org.uk/stockport-labour-consultaton-response-calls-for-end-to-can-kicking-on-social-care/
An opportunity to be backed by Legislation?
It is the view of Stockport Labour that the Government can and should use the ICP implementation process as an opportunity to achieve and work toward all the above points. This has then potential to represent a major step towards the successful integration of care, and subsequent improvements in clinical outcomes. However, it is important that more than just lip service is paid to these aims. The Government should be prepared to make legislative provision to implement the above recommendations if necessary.
This has a number of distinct advantages. These include the prevention of further differentiation between the approaches of different ICPs across their respective geographies. As such, this could help to prevent further differentiation in provision, reduce socio-economic gaps in outcomes and therefore act as a break upon the further development of the ‘postcode lottery’.
Moreover, overarching legislation could provide the public and partner organisations with the surety they need to back ICPs locally, allowing for greater likelihood of successful, swift and comprehensive implementation. This is much needed to help to end fragmented care provision, and as such could represent significant progress toward improving services for patients, the NHS, carers and service users.