Increasingly complex health needs in cities like Liverpool demand a seamless and integrated service to improve life expectancy and wellbeing outcomes, as Roz Gladden and Bernie Cuthel explain
The life expectancy gap between the longest living and earliest dying communities in the UK is roughly a decade. This lost decade is not easily explained in terms of class, race, sex or levels of deprivation, though these factors clearly have an impact, as the recently launched Public Health England website Longer Lives attests. Residents in comparable areas are living significantly different lives.
In Liverpool, an area where residents die earlier than in virtually any other part of England, we are looking at factors that enable people to extend their lives. By changing the way our health and adult services work together − creating a seamless and integrated service − people can take more control over their health and as a result, health and wellbeing outcomes.
The point of integration
Research shows that personal independence is a major factor in determining health outcomes. As people are living longer and their health needs become more complex, integration, not separation, is the only approach that will meet the increasingly complex needs of our communities. Crucially, the point of integration is to enable service users to take more control over their health and wellbeing outcomes.
‘Separate systems of health and social care will no longer adequately meet the needs and expectations of increasing numbers of people’
The current approach is not working as well as it should or could; however, by putting our strengths together we can provide the opportunities for our communities and help close the gap and reduce health inequalities.
The partnership being developed in Liverpool is about working as one integrated service. Under the proposed framework, Liverpool Community Health Trust will work with patients to provide the best healthcare for their condition, and Liverpool City Council will work with carers to provide a living environment that meets their, and their loved ones’, expectations.
A year ago, Joe Anderson, the Mayor of Liverpool, set up a health commission to challenge our whole health economy to reduce duplication and to strengthen the relationship across acute and community services. Currently, the patient experience of health and social care is characterised by duplication, bureaucracy and a lack of integration between providers.
Take health assessments, for example. It’s not unusual for patients to be subjected to five separate assessments from different health and social care services for the treatment of their condition. There is no reason why an integrated service can’t do this with one. The resulting efficiencies have the potential to improve waiting times for assessment even further as well as reduction in duplication for the service user and carer.
The impact of such duplication and bureaucracy is to effectively disable clients and patients and cause them, over time, to relinquish independence.
Often older people are admitted to institutional care for long periods when a package of assessment, treatment, rehabilitation and support in the community − or more support to their carers − might have served their needs, and maintained their independence, better.
Hubs of activity
Liverpool City Council has invested over £6m to develop new hubs that better support vulnerable adults in the community. This initiative has produced 85 reablement beds supported by multidisciplinary teams of staff from the council and Liverpool Community Health who effectively “wrap themselves around the service user and patient” with truly personalised care and support.
‘We are confident that integration will enable millions of people to claim back lost decades’
In the past 12 months, these hubs supported 627 episodes of care, allowing 56 per cent of the service users to return to their home independently without any further support and 44 per cent returning home with a care package. Fostering independence reduces costs and improves both health and wellbeing outcomes.
Compare this approach to outcomes in spot purchased intermediate care beds − with 52 per cent requiring long term care at home, 20 per cent admitted to permanent residential or nursing care placements and 28 per cent returning home with no ongoing care requirement. That’s more than one in four living fully independent lives.
The extra step
We should go further to ensure consistently good outcomes for patients, service users, carers and families. Separate − sometimes disjointed − systems of health and social care will no longer adequately meet the needs and expectations of increasing numbers of people, particularly those living into older age, often with multiple, complex, long term conditions, who need joined up, integrated support.
We are working together to develop a “section 75 agreement” for the joint provision of health and social care services to older people. The agreement would provide the legal framework for the trust and the city council to deliver health and social care services.
This sense of independence and personal control is further enhanced through the way in which patients and service users are communicated with and listened to.
Patient driven model of care
Ensuring service users have a say in how their service is designed and that they have an even greater say in the future seems like a possibility thanks to close working of social workers with the clinical commissioning neighbourhood integration model.
We have used patient insight programmes to refine the services in line with patients’ and service users’ needs. This work is focused on those with long term conditions who are most at risk of attending hospital unnecessarily and can be managed safer at home with better support from our multidisciplinary teams.
The economic climate and increasingly complex health needs are significant factors in prompting the change. But it was always the right thing to do. While the details of the partnership are still being developed, we are confident that an integrated, efficient and single service will lead to an effective and patient driven model of care for our communities. We are confident that integration will enable millions of people to claim back lost decades.
Roz Gladden is assistant mayor of Liverpool and cabinet lead member for adult social care and health; Bernie Cuthel is chief executive at Liverpool Community Health Trust