As January comes to its wet and windy end, there is no let-up in the raft of news about ambulances stacked up outside Accident + Emergency departments, overstretched staff and understaffed departments, thousands of unfilled nursing vacancies, centralisation of Radiotherapy Services away from Cornwall, and Minor Injury Units (MIUs), some of which may not have a long-term future.

Politicians, NHS and Council leaders say they have the answer to all of our problems: 'Integration of Health and Social Care'. On the face of it, it is a brilliant idea. In one fell swoop it delivers a joined-up service to patients and carers, whilst at the same time delivering financial restraint and reducing NHS deficit. The question that we at West Cornwall HealthWatch have is this: Why isn’t a joined up, better co-ordinated and more efficient health and social care system already happening? After all, the Health Act 1999 placed a specific duty on health and local authorities to work together and allowed them to enter into joint commissioning arrangements and establish pooled budgets. And statutory powers to force co-operation between the NHS and Local Government have been in place since 1974.

Those of us fortunate enough to have worked in the NHS in the 1970s and early 80s did work closely with social care colleagues. Integration was alive and well at a grass-roots level, to the enormous benefit of patients and staff. Collaboration was indeed the name of the game back then. So what went wrong, how did things change? The introduction of the internal market, which promoted competition and discouraged collaboration, gradually dismantled the foundation for an integrated way of working. The Coalition Government’s Health and Social Care Act 2012 completed the transformation to the reality of today’s NHS: a health service based on competition, with an organisational split between purchasers (Clinical Commissioning Groups) and providers (e.g. NHS Trusts). Fragmentation ensued, with many services contracted out to the private sector, resulting in complex and costly organisational arrangements. Each NHS body is now compelled to focus primarily on its own services and finances, rather than on working with others for the greater good of the population. This is what has created one of the main barriers to integration.

So what are we to make of Cornwall’s plan of setting up a ‘shadow’ Accountable Care System, bringing Commissioners and Providers from both the NHS and Cornwall Council together in one organisation? Basically, it looks like yet another top-down arrangement.  Will it remove the barriers to delivering integrated health and social care services at grass-roots level to the people of Cornwall, or is it primarily an exercise in empire building? We fear it will be the latter!

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Jan Williams and Peter Levin

© West Cornwall HealthWatch 2018