Despite years of effort to improve joint working across health and social care, progress remains uneven, an Audit Commission report has found.
While better joint working could deliver savings and improve care, the report found "considerable variation" between local areas. "Joint working should start with the needs of the person. This will, in turn, help to tackle system difficulties," it said.
Andy McKeon, managing director of health at the Audit Commission, said: "Most older people want to continue living independently in their own homes, if possible, avoid admission to hospital and, ultimately, die at home.
"Supporting them to do these things are key elements of health and social care policy. There are also savings to be made by reducing the use of expensive hospital or residential care.
He added: "Our evidence shows there is considerable local variation in achieving these aims. Progress will only be made by better integrating care locally. No one part of the public sector can successfully tackle the challenge of delivering good quality care with tight or decreasing budgets."
The joining up health and social care report, said integrated working offered the potential for greater efficiency and improved care, but it points out that the health and social care sectors need to be clearer about the outcomes they are trying to achieve.
In addition, partnerships should understand and use their local data, benchmark themselves against others and know what makes a difference.
As financial constraints bite harder, the report said, there is a danger that both the NHS and councils will focus solely in their own organisations when seeking efficiency savings, however. But the commission warns that cuts to one part of the care system can lead to unintended consequences elsewhere, such as new pressures or rising demand.
It calls on health and social care partnerships to focus on reducing unplanned hospital admissions, admissions to residential and nursing home care from the community, improving hospital discharge arrangements, and enabling people to die at home rather than in hospital if that is what they prefer.
As an example, it says that primary care trusts could save about £132m a year if areas with high emergency admissions reduced this to the national average. This money that could be invested to help people live independently in the community.
George McNamara, head of public policy at the British Red Cross, said joining up health and social care would fail unless community community-based care projects were funded and voluntary organisations brought into the loop.
"The Audit Commission is right to highlight the urgent need to have a sensible, joined up approach to health and social care. But unless community-based care projects are supported financially and people are given more help on their often complex and confusing journeys between the health and social care worlds, both systems will fail, with patients given the wrong care, at the wrong time, and in the wrong place.
He added: "Key to delivering a truly integrated health and social care are the newly formed health and wellbeing boards. We would like to see a stronger remit and more resources for these boards to overcome barriers to effective integration. Failure to do so will result in a missed opportunity to deliver more cost effective and personalised care."
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