In an ideal world, when a patient is admitted into hospital there is a deluge of information that comes with them. What medication they’re on, what symptoms they’ve presented with, any next of kin, and details of an existing care plan, for example. But Tracey Morrish, urgent care service manager at Northern Devon Healthcare NHS trust, says this isn’t always readily available, particularly for the hospital’s care homes team.
“A lot of the time it might be out of hours so you might not have the right person to pass over that relevant information,” she says. “Then you’ve got a diluting effect – the care home will tell the ambulance, the ambulance will tell A&E, A&E will take that information to the medical assessment unit, and then that patient will get passed on to a ward … at the end point, like in Chinese whispers, you might have something totally different to what you had in the beginning.”
Joined-up working between health and social care at the point of hospital admission and discharge has long been lauded as the ideal collaborative partnership, particularly when it comes to elderly patients who often pass back and forth between the two sectors. But with an estimated 1.5 million people employed by the NHS, and almost as many (1.49 million) working in adult social care (pdf), it’s a paragon that can be hard to achieve.
One of the main issues is building trust and respect, says Sally Gretton, Skills for Care’s head of Yorkshire, Humber and the north-east, and lead for integration. The organisation recently carried out an online survey of social care workers that found almost half (45%) of respondents (pdf) felt they were not treated with the same respect as other colleagues, and that this happened on a weekly basis.
“Registered managers feel they’re not part of the multidisciplinary team, they’re almost out of the loop,” Gretton says. “One of the key things for social care in its broadest sector is the feeling of powerlessness.
“[But] often social care providers are local people, they understand the local need, they’re often part of local communities. So they are excellent advocates for getting people together. It’s about opening doors and encouraging communication before the point of crisis.”
That research has fed into seven recommendations to improve joint working across health and social care. They include establishing a shared statement of purpose; developing clear pathways with a joint assessment process; creating clear lines of responsibility and accountability; and improving information sharing.
Rosalita Mainwaring, head of area in the south-west for Skills for Care, who worked as part of the research team, says there are some positive examples of this around the country. She has seen ambulance drivers develop good relationships with the local community team with clear plans for an individual about whether they want to go into hospital or not, as well as growing confidence from social-care providers. “[It’s about] care homes having the confidence to say: ‘No, this person wants to be here, they want to die here and we know how to deal with it,’” she says. “It’s about building up those skills.”
Alistair Whitmoor-Pryer, who runs care homes in Devon, including Asher Care in Newton Abbot, says his team have taken steps to improve how a patient is discharged from hospital into his care homes. “We’re very much seeing a change of attitudes,” he explains about working more closely with colleagues in the NHS.
In the past, he’s found there can be a tendency to underestimate the care a patient needs, particularly with those with dementia. “As professionals, we’re trying to link closely with community practice nurses, social workers, nurses, and doctors, way before admission [to the care home] starts,” he says. “We try to do a staged admission. We won’t take anybody unless we meet them.”
Improving communication is key, he adds, as is providing feedback on what’s not working. “We’ve had to champion that within our company at Devon and also with the authorities. We have to communicate with each other if we’re going to look for better care. So we’re making sure we have a voice for that resident or that family, and we’re not scared to challenge policies and procedures and say: ‘There’s a need here. We need more funding, or we need more input.’”
Morrish agrees. At Northern Devon trust, initiatives to improve communication have included the red bag scheme: the bag contains a “This is Me” document that covers what a patient likes and dislikes, their medication details, their family’s information and any professionals involved in their care.
The trust has also had some success transferring confidential information to care homes after setting them up with secure NHS email accounts. But overall it’s the relationships they’ve developed that have made the most difference. “What’s really good for us is having that relationship with the care home, so they feel able to come to us and say: ‘Actually that didn’t work’,” Morrish adds.
The social care sector has a lot to offer its healthcare colleagues, Gretton says. She and Mainwaring are hopeful that the expansion of schemes that span both sectors – such as integrated ambassadors, nursing associates and integrated apprenticeships – will continue to aid understanding and break down barriers.
“Despite all the pain, we are positive because there continues to be some really good work going on and people do really want to make a difference,” Mainwaring adds. “Health are getting on board with making sure the individual is at the heart of what they do, which is what social care has been doing for a long time. We’ve got a lot to give in terms of supporting them on that journey.”
Click here for Skills for Care’s resources to support social care providers and others achieve a seamless experience for people moving between health and social care
