Healthwatch: Integrated health service is just the tonic we need

It is no wonder that the public is becoming increasingly frustrated with the health and social care services in Oxfordshire.

The bureaucracy is formidable and difficult to penetrate. Getting an answer to a question is hard enough, assuming you can get to talk to someone in the first place. Getting an appointment with a doctor can be difficult, arranging an appointment at a hospital can be a daunting task, and as going to the hospital accident and emergency department is being discouraged you have to be very brave or very ill to attempt it.

As for complaining – well, forget it. A lot of people think it is a waste of time because no-one takes any notice and some are afraid to complain because they fear it will affect their future care. And to cap it all, some people in hospital find it difficult to get out because of muddly discharge procedures.

In the main people do not complain about the treatment they receive because in the vast majority of cases it is first rate. But there is no doubt there are severe communication problems at all levels of the health and social care service.

This was brought home to me this week when we summed up our year’s work in a report, a copy of which can be found at our website at www.healthwatchoxfordshire.co.uk Our small, energetic team has been dealing with the six different organisations who pay for and organise health and social care in the county.

Yes, that’s right: six different organisations and in total we raised hundreds of points brought to us by a puzzled public. As a result the authorities made more than 30 changes to their procedures as a result of our representations. Each of these changes may not seem to be significant in themselves but together the changes will make life easier for patients.

I must make it clear at this point that the authorities are not trying to make life difficult. What has happened is that the health reforms of four years ago made things worse rather than better and the current system fragments commissioning of services between three organisations, creating unnecessary bureaucracy and cost, neither of which we need in these times of austerity.

And it gets in the way of joined up services for the public. For instance, district nurses work separately from home care; children’s mental health services are split between three organisations; prevention services are separated from treatment services, and other children’s and specialist services are literally all over the place.

So, how do you put that right?

The answer being suggested by the Oxfordshire Clinical Commissioning Group, which pays for much of the health services in the county, is to get on with joining up the services from April this year.

Their chairman Dr Joe McManners and chief executive David Smith are proposing that the CCG takes on delegated responsibility for £85m from NHS England to finance GP’s services. They are also suggesting they work with NHS England and the government over the next year to take on devolved responsibility for all primary care and specialised services.

But the most important proposal is that they take the first steps to integration of the NHS and Oxfordshire County Council responsibilities with the current budget of £1.3bn and moving to a single management structure through strengthening the Health and Wellbeing Board, which is the body which has overall strategic responsibility for health and social care in the county.

As chairman of Healthwatch Oxfordshire I am a member of that board and unearthed a report which lamented the fact that the authorities have been talking about integration of health and social services for 40 years.

Is it too much to hope that we are finally getting there? If so there is a brighter future ahead and some of those communication problems that cause so much angst to the public could finally go away. The CCG approach is a commonsense and brave move and deserves to succeed.