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An Audit Commission briefing has found significant differences in the types of care received by people aged 65 and over across the country. It shows that despite the strong focus for many years on improving joint working across the NHS and social care, progress remains patchy.

Integrated working offers the potential both for efficiency savings and improved care. NHS and social care partners need to be clearer about the outcomes they are trying to achieve and how they will know they are making progress towards them.

Joining up health and social care is the second in a series of Audit Commission briefings looking at adult social care. It shows significant variation in levels of emergency admissions to hospital, and other indicators that raise questions about how well services are being integrated to meet the preferences of older people.

Andy McKeon, Managing Director of Health, 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. 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.'

At a time when the whole of the public sector must find significant savings, the briefing identifies potential efficiencies. For example, emergency admissions for people of all ages cost the NHS £11 billion in 2009/10. The report estimates that PCTs could have saved £132 million over that time period if they had all reduced admission rates of those aged 65 and over to the average level expected for a population with the same characteristics.

But without good integration, there is a risk of wasted effort and 'cost-shunting' where savings made by one organisation or sector create costs for others. Primary Care Trusts (PCTs), for example, can save money by reducing the number of people who are admitted to hospital in an emergency. But this may increase costs for the local authority.

Mr McKeon continues:

'There is a temptation when times are tough to withdraw into silos and limit your focus. We have seen this in the past. This instinct is misplaced. Real savings, and a better, more independent, experience for local people, can only be achieved through partnership, and a view of what constitutes value for money across both health and social care. Our briefing sets out some of the issues that partnerships should address, and suggests practical ways to do so.'

The briefing offers guidance to local partnerships, setting out a list of questions to consider, and suggestions for interventions that might help. Case studies show how some areas have embraced partnership working and used local data and benchmarking to establish how and where to make improvements.

Notes to editors

1. The Audit Commission is a public corporation set up in 1983 to protect the public purse.
2. The Commission appoints auditors to councils, NHS bodies (excluding NHS Foundation trusts), police authorities and other local public services in England, and oversees their work.
3. We also help public bodies manage the financial challenges they face by providing authoritative, unbiased, evidence-based analysis and advice.
4. In August 2010, the government announced plans to disband the Audit Commission and put in place new arrangements for auditing England's local public bodies.
5. The Commission is undertaking a procurement exercise to outsource the work of its in-house Audit Practice. Beginning in 2012/13, the Commission will award contracts of three to five years to private audit firms.
6. The government is currently considering responses to its consultation on the 'future arrangements for local public audit' that are intended to replace the Audit Commission.

For further information please contact:

Louise Neilan,
Media Relations Manager
Tel: 020 7166 2132
Mob: 07766 697 801
Email : l-neilan@audit-commission.gov.uk