The National Audit Office (NAO) has today published a report assessing the challenges preventing health and social care from working together effectively. In a move to encourage the government to create a long-term plan for a sustainable, joined-up care sector, the head of the NAO, Amyas Morse, is urging further and faster progress towards a service that centres on the needs of individuals, meets growing demands for care and delivers value to the taxpayer.

Since the NHS was established in 1948, health and social care needs have changed significantly with an ageing population and greater demand for long-term care, but the separation between the health and care sectors has remained. The government has made slow progress towards its longstanding objective of changing the way these services are delivered through better integration, an objective reiterated in the NHS’s Five Year Forward View.

The NAO’s report draws together the NAO’s experience and unique perspective of auditing the NHS and local government’s approach to delivering health and social care. It aims to contribute to the ongoing debate about how to improve joint working across health and social care in England.

The report anticipates the green paper on the future funding of adult social care, now delayed until the autumn, and the planned 2019 Spending Review, which will set out funding allocations for both health and local government. It also acknowledges the government’s recent announcement of funding increases for the NHS up to 2023-24.

The NAO has set out why closer working between health and social care is important, as well as the key strategies and initiatives that government and NHS England have put in place. The report examines the challenges in bringing this about and the work being carried out nationally and locally to overcome these challenges. It also addresses some of the key financial challenges facing both the NHS and local government and how these impact on joined-up working, as well as cultural and structural barriers which hinder decision making, and strategic issues which inhibit central and local planning.

The report finds that the financial pressure that the NHS and local government are under makes closer working between them difficult and can divert them from focusing on efforts to transform services. Short-term funding arrangements and uncertainty about future funding make it more difficult for health and social care organisations to plan effectively. Although the report acknowledges the recent announcement of extra funding for the NHS, additional funding has, at times, been used to address financial pressures, rather than to make essential changes to services or adopt new technologies.

The report makes it clear that the NHS and local authorities operate in very different ways, and both sides can have a poor understanding of how decisions are made. Problems with sharing data across health and social care can prevent an individual’s care from being coordinated smoothly.

The report finds that new job roles and new ways of working could help to support person-centred care, but it is difficult to develop these because of the divide between health and social care workforces. A joint workforce strategy is currently in development. With social care now accounting for over 50% of local authorities’ overall spending, it is vital that the NHS and local government work effectively together to support person-centred care.

“No one across government or the civil service would disagree that health and social care have to be in balance to give people quality of life, and to use the available national and local resources as efficiently as possible. The hard part is agreeing how that balance is to be achieved and maintained, and who is willing to sacrifice what to bring it about.

“The NHS did not like funds being syphoned off through the better care fund, whilst local government has reservations about sacrificing over half of its financial resources towards NHS England’s priorities, which risks eroding local democracy. The answer may lie in local flexibility, but that could leave serious gaps in delivering what is needed – an integrated service. Serious political leadership is needed.”

Amyas Morse, the head of the NAO

Read the full report

The health and social care interface

Notes for editors

  1. The NAO’s report on the health and social care interface draws on its work examining the health and social care sectors, to highlight the barriers that are preventing health and social care working together more effectively. The NAO has also examined recent research and reviews by other organisations, including the Care Quality Commission’s review of health and social care systems in 20 local authority areas, carried out between August 2017 and August 2018.
  2. The NAO (and its predecessor body) has worked with the NHS since its formation in 1948, helping to save money for UK taxpayers and raising awareness of areas where the government needed to focus its attention and improve care. For details of the measurable impact the NAO has had in this area, please get in touch.
  3. Press notices and reports are available from the date of publication on the NAO website. Hard copies can be obtained by using the relevant links on our website.
  4. The National Audit Office scrutinises public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Sir Amyas Morse KCB, is an Officer of the House of Commons and leads the NAO, which employs some 785 people. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services. Our work led to audited savings of £734 million in 2016.

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