Anyone operating in social care is aware of the importance of integrating health and social care. We have a perfect storm of an ageing population, increased numbers of people living with long-term conditions, squeezed local authority budgets, discrepancies between the fees paid by private clients and councils, high staff turnover, increased operating costs and that’s just social care.
The NHS is at breaking point, accident and emergency departments can’t function through the winter, there are insufficient beds to meet demand, older people are admitted to hospital and then struggling to get back out again leading to bed-blocking, amongst other things. It’s obvious something needs to change.
When it comes to funding, the NHS budget is protected, with the Government committing in the recent Budget to increase spending by £10bn per year in real terms by 2020/21. Although some of this money has to go towards service transformation including integrating with social care, the social care budget via local authorities is continually being squeezed. However, they work hand in hand, if health and social care came together costs could be saved, lives could be improved and pressures on all services could be reduced.
A new report by Ian and Stephen Smith sets out plans to reform the systems and address the ‘vicious circle of a broken down health and social care system’.
Ian R Smith is a leading name in social care. He is the Chair of Four Seasons Health Care and has held a number of high profile positions in business including Chief Executive of General Healthcare Group which owned and operated private hospitals.
Professor Stephen K Smith is a Professor of Medicine who set up the first academic health and science centre at the Imperial College Healthcare NHS Trust. Together they have published, in a personal capacity, their proposals for the reform of the health and social care systems. Originally published in the Health Service Journal, Away from the past and to a sustainable future. How the UK’s health and social care systems can be reformed to better align with the needs of today’s society, sets out their vision. This includes a new type of integrated care organisation keeping people out of hospitals. Hospitals themselves will become academic health science centres consolidating clinical practice and research to deliver personalised medicine to improve health outcomes. They argue that the existing structure of specialist facilities currently in local hospitals isn’t the best way to meet patient needs.
Integrated care organisations
The integrated care organisations that they propose will remove the boundaries between health and social care, acute and chronic medicine, generalist and specialist skills, primary and secondary settings, episodic and preventative interventions and physical and mental health.
The model would enable health and social care providers to work together to deliver care focusing on the individual that manages their needs, whether physical, social or mental. It would bring together GPs with social workers, mental health experts, pharmacists and diagnostic technology in large health centres.
The model would support personal, lifetime care pathways rather than individual episodes of care (such as from home, to intermediate care facilities, to hospital and back home), with each patient having a ‘case manager’ who will navigate them through the system. This would be made possible by a rapid introduction of electronic patient records in a connected digital network.
Clinicians would be separated into generalists who would consider the ‘whole person’ in their social setting and specialists based within hospitals, advancing medical science and practice. While the integrated care organisation would need to draw on a balance of specialists and generalists, they say that there is a strong case to consolidate the specialist expertise, for example, in cardiology or cancer into centres of excellence. This will mean fewer but larger clinical units.
Moving forward with reform
Ian and Stephen agree that there needs to be a strategy for reform to integration – something that is echoed throughout Government, think tanks and wider sector leaders. However, they are realistic to the barriers, including constant reorganisations affecting the system, complex management structures, an under-supported workforce, fragmented regulation, funding constraints and, of course, politics.
Ian Smith explained, ‘We do not under-estimate the enormous political challenge involved. This is in no small part because for more than half a century the NHS has been an election campaigning issue, with the major parties vying to persuade voters they can be trusted to ensure its future. This has created the public expectation that the ultimate goal should be to preserve the status quo.
But perpetuating that myth does our society a great disservice and in the long-term it is unsustainable. There is a compelling case for change to put the UK again at the leading edge of health and social care outcomes, just as the establishment of the NHS and social care systems did in 1948.
The integrated care model that we propose is realistic and achievable, but we recognise that others may have thoughts on how health and social care could be developed.’
Over to the experts…
There are many thoughts and strategies for reforming health and social care. If it is universally agreed that integration is the best way to ensure sustainable services, fit for the future, are the integrated care organisations proposed here the solution? Also, how do we get the reformed system that is so desperately needed?
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