In its 1948 constitution, the World Health Organisation (WHO) defined health in its broader sense as “a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity”. At that time, this formulation was visionary and groundbreaking because of its breadth and ambition. It overcame the negative definition of health as absence of disease, and included the physical, mental and social domains.
Unfortunately, over the past 69 years, it has never been adapted. Over the years, scholars have questioned the absoluteness of the word “complete” in relation to wellbeing. However, in my view, the concept of integrated care as a means of sustainability for the National Health Service is the only way forward.
Since 2010, the NHS budget has been almost static. Meanwhile the UK population has increased by 2.5 million and is predicted to grow by 440,000 a year over the next ten years, with a growing proportion living longer and having more long-term illnesses. The NHS in England is facing consistent hospital black alerts, persistent under-delivery of elective surgery, fragmented health services, management aimed at meeting targets, years of fiscal deficits and a future that looks increasingly fragile. Financial and operational performances have deteriorated sharply, and the additional resources allocated to the NHS by the Government are being used mainly to reduce hospitals’ deficits.
It is clear that a different approach is required. Continuing to work in the same way is no longer tenable and is failing a community that has a right to expect better. The NHS England is seeking to transform how health and social care services are designed and delivered in the face of increased patient expectations, constrained resources, an ageing population and advancing technology.
One way they are trying to do this is through a range of ways intended to transform the delivery of care, one of which is to integrate health and social care services at the local level. Integration is about placing patients at the centre of the design and delivery of care with the aim of improving patient outcomes, satisfaction and value for money. Rising demand for care services, combined with restricted or reduced funding, is putting pressure on the capacity of both local health and social care systems.
NHS England is responsible for supporting clinical commissioning groups and for the commissioning of NHS services overall. The two departments and NHS England are trying to address funding and demand pressures by supporting local authorities and NHS bodies to integrate services.
It appears that the first aim of the new planning process is “sustainability”. However, what is truly unsustainable in the long run is trying to providing a first-class health service on a third-class budget. The foundation trusts, local authorities and CCGs all have massive deficits.
Without a radical change in the Government’s austerity policy, services are threatened with collapse. When services are duplicated or organisational boundaries prevent access to care, as is the case with the current health and social care systems in England, patients’ fundamental needs are not met and resources are wasted. Truly, you need a whole system to work for the whole system to work.
Integrated health and social care with desired outcomes is possible but it takes time and genuine engagement with staff, patients, users and other stakeholders. Leadership of change must be collective with distributed responsibility and guided by a compelling shared vision and narrative.
Integrated services, collaboration between local authorities, CCGs and hospital sector, collaborative working and shared services between local councils and other public bodies, making economies of scale may have a legitimate role to play in delivering these objectives if done in the right way.
However, the concern remains that shared service initiatives are often used as a Trojan horse for the privatisation and increasing marketisation of public assets, instead of properly funding the delivery of public services.