It’s difficult to avoid commentators, politicians and pundits referring to health and social care (H&SC) integration in their presentations, announcements and statements these days. The divide between H&SC already has a huge impact upon the quality of life of services usersas well as adding a massive cost pressure to the system. For the most vulnerable, getting caught in the gap where healthcare ends and social care starts is now normal. The older population and their carers – most often spouses who themselves will commonly have health problems of their own – are often those most at risk from the disconnection of services.
The Better Care Fund sets out a desire to integrate H≻ however, many areas have lost a sense of meaning on this. Instead, the focus in these areas has been on NHS integration, promoting the model of vertical integrationbetween primary, community and secondary care services. Bucking this trend, the high profile DevoManc plan in Manchester aims to break down territorial and protectionist attitudes to budgets, hierarchies and jargon. I remain hopeful that the hero innovators for real change will soon be followed by increased numbers of early and then majority adopters.
There is a simple equation to what seems to be happening: squeeze social care with yet more cuts (forecast to be another £3bn) and older vulnerable people found in a neglected, struggling and distressed state will be quickly whisked off NHS hospitals adding to the already massive capacity problems .
Diabetes is one example of a clinical priority . Someone with diabetes is admitted to hospital from a care home every 25 minutes, and we know that one in four of the estimated 400,000 people living in residential care in England has diabetes. We also know that of all diabetes related admissions ( more than one million people each year), 87% are emergencies and 80% of the 10% total spend the NHS provides is addressing the complications of diabetes care.
One in four beds are occupied by a person with cognitive impairment and the occupied bed day figures show that a staggering 40% of people in a bed have no medical reason to be there. Studies show bed day costs are well in excess of £500 per day for a person with dementia staying on average 21 days.
This last point brings me to the key issue for a genuine can doattitude to true and proper H&SC integration. There are imaginative and challenging alternative models of care contributions that can be offered by 24/7 care providers, who can give substantially better outcomes to older people - especially for those with dementia in care homes.
Surely, one of the priorities for action in the Five Year Forward View should be keeping people out of hospital and getting people out of hospital, and these aims should be driven by choice, best care and cost effectiveness as measure factors. There is hope that the 29 vanguard pioneer sites (where six are working with care homes) can ensure better connectivity. Our local services and Devon-based care home quality kite mark movement are engaged with senior NHS leads to join in and add enthusiasm and credibility to the debate. But sadly, our involvement as a 24/7 care provider is the exception not the rule.
This must change, and we must address the ongoing issue of the great disconnect between H&SC . A recent Alzheimer’s Society survey tells us that three in five GPs (61%) report a lack of co-operation between H&SC and that patients are being let down. Care Homes are part of the solution, bringing both active and positive energy to the system, if included. In Devon we are slowly becoming part of the care revolution sorely needed to reflect the changing demographic. Hopefully, it’s not too late for care to change.
Please note that the views expressed in this blog do not necessarily represent the views of Skills for Health.
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