THE latest buzz phrase in health and social care is “transformational change”. Integration Joint Boards (IJBs), the latest attempt to shift the focus of care away from hospitals and into the community, are starting life with budget black holes and a pressing need to make savings.
The policy is widely supported. Hospitals are not the best place for long term care, particularly for older people. The clear evidence is that, with the right support in their own homes, patients will remain healthy and active for longer.
The implied need is to reduce the amount spent on beds and staff in hospitals and transfer that gradually to neighbourhood-based health and care services. This is difficult to do, because until community services are adequate, hospital wards cannot be closed. The policy is sound, even if getting there is not easy.
But what is not explicable is reducing the amount spent on community-based care. Plans being presented to Glasgow City IJB next week propose savings totalling £5.4 million – and they are justified by talk of transformational change. There may be efficiencies to be had in better organising existing social work and nursing initiatives across the city and reducing management duplication.
But the danger is staff without sufficient clinical skills deciding whether to admit a patient to hospital or provide care at home will, instead, admit them before the decision, cutting across the stated goals of health and care integration.
It defies credulity to read the reports on Glasgow repeatedly claiming “efficiencies” will improve services despite eye-watering budget reductions.
The worry is not Glasgow’s alone, as we know other IJBs (Dundee, West Dunbartonshire, Aberdeen and Fife among them) also face funding gaps. If they follow a similar model the future for health and social care integration looks bleak. The Scottish Government insists IJBs have sufficient funds.
But that claim looks increasingly dubious. Such a level of cuts could mean the likeliest transformation being a collapse in public confidence in this flagship policy.
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