Health and Social Care Integration and New Commissioning and Organisational Models

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2017 Health Care Service Group Conference
13 December 2016

Health Conference welcomes the growing acknowledgement in the public policy discourse that our health and social care systems are inter-related and interdependent.

Health Conference believes that, where there are problems with the availability and quality of social care provision, the knock-on effects are felt in the NHS – both in increased demand for front-end health services and greater difficulties in discharging patients into the community.

Health Conference notes with concern the systemic underfunding of council-commissioned social care services caused by years of central government cuts to local authority budgets.

Health Conference further notes with concern that the social care sector is characterised by predominantly low-paid private sector employment and a funding regime that involves user charges and means testing.

Health Conference notes that:

1)NHS commissioners are increasingly working together with council commissioners in taking more joined-up decisions about health and social care provision.

2)NHS provider organisations are increasingly becoming part of various new organisational forms (‘new models of care’) that involve them more closely in the provision of social care services.

Health Conference believes that these moves toward more integrated commissioning and organisational arrangements hold some potential to improve services through making the patient experience more seamless, treating more people in (or closer to) their own homes, and improving work on prevention.

However, in a context of underfunding for both health and social care, Health Conference is concerned that the current policy direction also holds threats including:

a)More expensive acute services could be decommissioned to meet cost targets before improved community provision is both in place and proven in practice to reduce the need for acute care. This could lead to significant unmet need.

b)Efforts to cut costs may involve the integration of so-called ‘back-office’ functions that could lead to job losses and could prove to be a false economy where medical staff are required to undertake more administrative work.

c)Where staff on NHS and council terms and conditions are brought together there can be complications in regard to a number of employment issues such as job evaluation and continuity of service.

Health Conference calls on the Service Group Executive to:

i)Provide branches with information about the various new organisational forms emerging such as integrated care organisations.

ii)Collate good practice from around the country.

iii)Issue comprehensive advice to branches and regions on equal pay issues where staff are doing similar work drawn from the same funding source.

iv)Work with the local government service group to agree a ‘one union’ approach to proposals

v)Develop a bargaining strategy to defend and extend NHS terms and conditions in new integrated care organisations, and to resist the further privatisation of NHS services.