The prime minister’s review of health and social care integration offers the chance to start backing up potentially life-changing schemes with culture change and resources, says Mike Adamson
The long-term rising pressure on our health and social care system is perhaps inevitable given the combined pressures of an ageing population living longer with a range of needs, new expensive treatment options and budgetary constraints.
It is a form of perfect storm, bound to lead to a plethora of real problems from hospital bed shortages and lengthy waiting times to the isolation of our society’s most vulnerable members. The past week has seen the spotlight shone on many of our system’s current failings.
This is an emotive subject – it’s about how our families are cared for when they are at their most vulnerable. In recent days the debate has been overshadowed by whether this constitutes a “crisis”, how much money has or hasn’t been invested and who’s to blame.
Through our work, assisting people in the gap between home and hospital, we see the long-term additional strain that cuts to social care are putting on the NHS
However, out of that there is also now a growing consensus that something has to change to solve the problem and create a health and social care system that matches people’s needs and prevents them reaching the point of crisis whenever possible.
The health and social care systems cannot be separated. They are interdependent – if one is stretched the other feels it. The problem that a lack of social care is causing to the health system is well documented. Of the 193,700 hospital days lost to delayed transfers of care in November 2016, 35 per cent were attributable to a lack of social care that means too many people have nowhere else to go for support at home.
Despite an increase in demand, at least half a million fewer people are receiving support than 10 years ago. People are going without basic support with feeding and washing. Others are unable to access the transport necessary to get to their GP appointment. Through our work, assisting people in the gap between home and hospital, we see the long-term additional strain that cuts to social care are putting on the NHS.
Because of budgetary constraints, £4.6bn was cut from adult social care between 2010 and 2015. At least £1bn extra is needed each year up until 2020 just to continue providing care at current levels.
However, we believe the solution is not just about pumping more money into the system. It also needs a culture change and a recognition that there are small things that can add up to big solutions. The danger is that people demand a big bang solution, whereas this will actually take painstaking hard-work and a joint approach.
Our tendency is to work in silos between medical departments, community services, social care and the voluntary sector. We need to work together to see the patient in the round and start from what they need
The culture change is about how the system works: our tendency is to work in silos between medical departments, community services, social care and the voluntary sector. We need to work together to see the patient in the round and start from what they need.
I remember watching as one of our volunteers sat for an hour with a woman, in her 70s and recovering from a hip operation, repeatedly asking “what do you need to get better?”. She needed mobility aids, yes, but she also needed someone to help give her confidence to get back on the bus, to go to the shops, so she could start again to be self-sufficient. That’s the point we need to start at. A long term, person-centred solution, developed in partnership, across parties, professionals and other organisations is needed.
The cost of loneliness
There are actually some relatively simple, smart interventions that could be made that would amount to a potentially dramatic difference to the whole system. We need to speed up access to medications and wheelchairs on discharge so people can leave hospital more quickly.
We need to know people are going home to a safe place, that the heating is turned on and that they will be fed, so they don’t end up in hospital again. We are increasingly understanding the cost of loneliness on people’s health and the triggers for it. We need a society that responds quickly to help people get back on their feet again and a health and social care system that prioritises that.
Rather than investing in services that prevent, reduce and delay the need for further support, with overstretched funds, local authorities are struggling to help those with even the greatest of needs
The Care Act 2014 paved the way for the biggest reform of social care in over 60 years. For the first time, new duties and responsibilities to shift towards prevention were placed on local authorities. Yet, almost two years since it came into force, prevention budgets continue to fall.
Rather than investing in services that prevent, reduce and delay the need for further support, with overstretched funds, local authorities are struggling to help those with even the greatest of needs. We’re fighting fires rather than preventing them.
Other ambitious initiatives have since been introduced, such as the Five Year Forward View, sustainable transformation plans and the devolution of integrated health and social care budgets. But to really mean something, they need to be met with extra resources and a change in thinking that approaches this collectively as medics, carers and commissioners.
We welcome the prime minister asking for a review of care and integration policy. It’s an excellent opportunity to explore long-term, person-centred solutions, and what is needed to see them properly implemented. If we can develop this in partnership, across parties, professionals and other organisations we could start to build a future in which our society’s most vulnerable people will get the care and dignity they deserve.
Mike Adamson is chief executive of the British Red Cross