Health select committee to say government's health reforms have failed to integrate care for a rapidly ageing population
Andrew Lansley's NHS reforms have failed to come up with the plans and the cash for an integrated system of health and social care to cope with an ageing population, a group of MPs said on Tuesday.
The health select committee says that elderly people are deeply reliant on public services, accounting for 50% of those in social housing, 70% of hospital beds and 91% of those needing nursing care.
Despite ministerial promises, the MPs say there is no "joined-up approach" to dealing with elderly people. The committee warns that "although the government has signed up to the idea of integration, little action has taken place to date. The committee does not believe the proposals in the health and social care bill will simplify this process."
The MPs take issue with ministers who said the most "integrated" parts of the NHS – where social care and health budgets were brought under the control of a "care trust" – were "experiments which are now over".
The committee says that by ensuring elderly people get help at home rather than waiting until they can only be treated in hospital, care trusts have reduced the number of hospital admissions by 30%. Stephen Dorrell, the chair of the committee, said ministers had not reached an "attractive conclusion [by saying] these were experiments that were now closed".
Dorrell also questioned the government's assertion that there was enough money for councils to pay for care for elderly people. Ministers had claimed that they were putting an extra £2bn into local authorities' social care budgets.
The committee's report says that this is "not sufficient to maintain adequate levels of service quality", while an analysis for the King's Fund says a funding gap of £1.2bn could open up by 2014 unless councils can achieve unprecedented efficiency savings.
Many experts say that elderly patients are left confused by a system where they have to repeatedly give their details, undergo unnecessary repeat tests, and are left on their own to negotiate with councils, the NHS and welfare agencies.
The NHS Confederation, which represents managers in the health service, said that "while promotion of integration is written into the bill, the creation of new bodies and the division of responsibilities for various services risks fragmenting care more, rather than less. This is a particular worry for older people, who tend to have more than one illness and so require integrated care from different services across health and social care."
In a damning assessment, the MPs say Lansley's reforms are built on the "hope" that GPs, hospitals and councils will respond to payments for working together. Instead, the MPs argue that there should be a body set up just to commission services for elderly people, drawing on budgets from health, social care and welfare.
The committee also said that the proposals put forward by the economist Andrew Dilnot for capping the amount of money that people were liable for to pay for care in their old age were "an important element... but not the whole answer". Both Labour and the government are seeking consensus over the vexed issue of social care but so far talks have yielded little.
Labour said the select committee had shown that instead of "focusing on what older people and their families really need, the government has instead wasted 18 months on its disastrous and wasteful NHS reorganisation".
Liz Kendall, the shadow social care minister, said: "Some of the best examples of integrated care have been achieved by care trusts, which will be swept away by the government's own bill."
The minister for care services, Paul Burstow, said: "We know that urgent reform of the care and support system is needed. We will be responding to this report and the Dilnot Commission this spring, with full proposals for reform of adult social care in a white paper and progress report on funding reform.
"Integrated care should be the norm. That's why we asked the NHS Future Forum to specifically work on this issue. They told us there is no single silver bullet when it comes to integration."