22.We heard that the health service is at a much earlier stage and is moving forward more slowly than the social care sector in implementing personal budgets and direct payments. Health staff are more risk-averse than social care staff as they are used to managing and mitigating clinical risks. They find it a challenge to move away from conventional medical treatment, for example, the idea of improving a patient’s respiratory function by buying them a trampoline rather than using a physiotherapist. The NHS is finding implementing personal budgets to be more staff-intensive than first envisaged. There is concern that personalised healthcare will require more resources than conventional healthcare when expanded to include all patients with long-term conditions.
23.We heard personalisation can support the drive to integrate health and social services. A simple approach to integration is to integrate services around the individual using a single sum of money. The Department is currently piloting integrated health and social care personal budgets with nine local areas. However, integrating health and social care budgets requires local authorities and health bodies to overcome the barrier that the NHS is free at the point of delivery whereas social care is means-tested.
24.The witnesses representing the health and social care sectors told us that defining measures of user outcomes that jointly covered health needs and social care needs would be better for care users. They suggested that this could be achieved by combining the separate health, adult social care and public health outcomes frameworks into a single framework, which would encourage care professionals to think how health and social interventions might work better together to address people’s needs, and how the health and social care systems and structures could work together properly. The Department, however, does not consider merging the separate outcomes frameworks to be desirable. Instead it advocated using existing measures within the frameworks that give a holistic view of how local services are working together, for example, the proportion of older people still at home 91 days after hospital discharge. It told us that the way to drive integrated care services, centred around the user, is to undertake joint health and social care assessments leading to single care plans.
25.We heard that many older adults with care needs and disabled people are living in unsuitable housing. Supported housing is particularly important for some adults with high care needs, but we are concerned that changes to the housing benefit system mean that some people will have difficulty renting supported housing. The Department was very clear that an individual’s housing needs should be considered alongside their care and support needs, and that the two could not be separated.
26.In our view the long-term planning of housing has not been properly linked up with adult social care and healthcare policy. The Department told us that it is fully engaged with the Department for Communities and Local Government and the Department for Work & Pensions in the discussions around the Local Housing Allowance element of housing benefit. We heard that the Department is keen to ensure that changes to Local Housing Allowance do put additional pressure on social care provision. The Department is concerned that uncertainty around rates of housing benefit will lead to a slow down in the building of supported housing. We heard from the Department for Communities and Local Government that it is examining how supported housing should be funded and supported in the future.
27.Many adults with care and support needs receive state benefits, for example, Personal Independence Payments or Disability Living Allowance. We know from speaking with our constituents that some do not understand why their money comes from several different sources, and they find it difficult to navigate through a system of support that they find complicated. They find it difficult when parts of the system change, for example the transfer of the Independent Living Fund from the Department for Work & Pensions. We do not believe that a system that requires people with complex and long-term needs to seek support and money from several sources is an efficient way to fund their needs.
28.The Department told us that some of the fences around these different sources of money are justified, so that money is fairly allocated to different categories of need. However, it acknowledged that the landscape is complex and evolving for individuals, and that better coordination would help. The Department suggested that local areas with devolved powers could usefully pilot ways to join up such support.
2 June 2016