A Question of Behaviours

NHS and Councils Need to Gamble Big With Health and Care Integration Fund To Succeed

The NHS and local government are at risk of wasting the £3.8billion of money available in the government’s Health and Social Care Integration Transformation Fund (ITF) according to ‘A Question of Behaviours’, a new report from behavioural insight specialists IMPOWER. The report argues that current integration plans could mean another expensive health care re-organisation because of the failure to take into account longstanding professional and public behaviours.

Health and Social Care Integration has been feted as a significant part of the government’s answer to increasing pressures on acute care services presented by elderly and frail patients. However, this report calls into question the effectiveness of this programme based on its current trajectory and argues for a sharp reflection on approach. The report notes that we could be just around the corner from another unsuccessful restructuring exercise due to unaddressed breakdowns in professional relationships across the health and care services. GPs, in particular, have a hugely critical role in making integrated care work but the report has thrown up some startling insight into how big a challenge health and care providers are facing.

• 56% of GPs rated their relationship with adult social services as either poor or unsatisfactory
• 47% of GPs rated respite services in their area as either very poor or unsatisfactory
• 49% of GPs rated the quality of hospital discharge as either very poor or unsatisfactory

The report calls on the NHS, local government and Whitehall to alter their current approach towards health and social care integration to one that focuses on the behaviours and relationships of professionals and the public.

Report author Alex Khaldi said:

“The data shows that we’ve got a serious problem. Professional relationships and patient behaviours are the key tools we have to keep people out of hospital and making local, integrated care really work. Without a significant focus on the behaviours and relationships of professionals and the public there’s a genuine possibility of us walking blindly into another expensive and unsuccessful restructuring. Councils and the NHS are making a big bet that integration will solve the urgent care crisis. But the odds for success are very long if yet another big restructuring is seen as the answer.”

Sandie Keene, ADASS President:

“The findings are fully consistent with the ADASS view that achieving the most from integration depends on changes in system leadership, and an unremitting focus on outcomes for people within localities. The message that we have to concentrate on getting relationship right at the front line, too, is absolutely spot-on, as is the reminder that it is behavioural change, not system change, that will make all the difference.”