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Health and social care integration: Rising to the challenge

Kevin Fairman and Sandra Payne explore how their organisation has stepped back to review its progress with health and social care integration and highlighted best practice to share with the sector.

The sector, and particularly those providing care and support for older people, are eagerly awaiting the Government’s Green Paper on older people to be published in Summer 2018. As part of this, organisations in the sector have repeatedly called for the lack of funding for social care to be addressed.

However, as well as the systemic changes that we hope lead on from this Green Paper, there is a lot of outstanding practice going on in the sector on a day-to-day basis which needs to be shared.

Added to this is the ongoing drive for health and social care integration, but what does this mean and how does integration work in practice?

It is with these points in mind that in February 2017, a cross-functional working group within Brunelcare was created. It was challenged to compile and publish a report evidencing how the charity contributes to the integration of health and social care within the South West.

The aim of the subsequent report is to share some of the outstanding practice that was identified, which may benefit similar organisations and the people they support.

The working group comprised managers from the following areas of expertise within the organisation:

  • Health and wellbeing service to sheltered housing tenants.
  • Falls management.
  • End of life care.
  • Homecare and community reablement services.
  • Pathway 2 Reablement services.

Integration within the health and social care system is defined in many ways, but we established it to mean the co-ordination of care provision for service users; exploring how care teams work efficiently with the NHS, care commissioners and other care providers within the region.

NAO report

A key focus for the working group was to respond to the National Audit Office (NAO) report Health and Social Care Integration published in February 2017, exploring how the organisation’s work supports or challenges the findings.

Much of the NAO report made disappointing reading, warning that progress on health and social care integration in England has been slow and not delivered the expected benefits for those cared for, the NHS or local authorities.

The Better Care Fund, the Government’s main integration initiative, did not achieve the planned savings of £511m, and delays to transfers of care increased by 185,000 rather than the planned decrease of 293,000.

Highlighting evidence

In gathering evidence, the group decided it would be easier to focus on two specific elements:

  • Reducing hospital admissions.
  • Reducing the delay in transfer of care from hospital to other settings.

The completed report, Integration of health and social care: Rising to the challenge describes many initiatives we have developed that have led to improved outcomes for the people accessing services under these two elements.

Examples include a falls project, end of life care work, Pathway 2 Reablement, and a health and wellbeing officer pilot; all of which also show best practice.

Falls management

Regarding falls management, an innovative and outcome-focused falls management system within our care homes resulted in a 32% reduction in falls across all four homes from 2015 to 2016.

A council-funded falls management project, led by Brunelcare, was also successful in improving the management of falls in many other care homes in Bristol; with evidence generated from this project enabling further funding to be secured from NHS England to continue work on falls management in care homes.

Reablement

In 2014, we worked with clinical commissioning groups to develop Orchard Grove Reablement Centre, where patients who no longer need a hospital bed but are unsafe to return home, stay and receive care and support before returning home safely.

As the first reablement centre created by an independent provider (and registered charity) in Bristol that year, the centre evidences how it continues to make a difference.

To get patients out of hospital in a timely manner, the centre’s teams ensure beds are turned around quickly and liaise closely with the hospital discharge teams. The average length of stay is 41 days and we monitor delays in transfers of care, sending this information on to commissioners.

End of life care

Working in line with the Gold Standards Framework guidelines for end of life care, our care teams work closely with partner GP practices across all care homes.

Following a multi-disciplinary approach, care teams use best practice guidelines and work collaboratively with fellow professionals. By doing so, this impacts upon colleagues in the NHS as expected deaths are managed more effectively in the care homes, reducing costly hospital-based care and emergency admissions.

Health and wellbeing officers

There is also evidence of the innovation and impact delivered by new health and wellbeing officers, initially funded by Bristol City Council’s Supporting People pilot.

The now permanent health and wellbeing officers help 1,000 sheltered housing tenants in Bristol gain better access to the range of health and social care services from us, the NHS and the local community. The health and wellbeing officers evidenced a notional saving to the NHS of approximately £179,600 in hospital bed care due to the reduced hospital stays for their housing tenants. This was over a six-month period when comparing 2016 and 2017.

Strong relationships

Working in partnership with GPs, local hospices and secondary healthcare colleagues has strengthened our reputation in local communities and helped us to maintain our standards.

However, it’s not without difficulties. Persistence in pursuing what is right for the individual is required at all times. Our domiciliary care teams often hit barriers in getting people home from hospital. This can include communication within hospital departments, transport not being arranged, the wrong type of transport, wrong transport time or medication not being ready.

All teams in the working group frequently mentioned building strong working relationships with occupational therapists, hospital social workers, and discharge liaison teams as essential to the success of their work.

Ultimately, our joint-working has been better informed by looking into our integration practices and the information that has come from it, along with the time taken to share lessons and reflect on current practice across all our key operational teams.

It has been extremely valuable to gain an overall sense of progress; and the limitations and continued challenges we face with the joined-up approach we apply to our work.

Learnings

Ultimately, we support the NAO’s findings that expectations of the rate of progress with integration are over-optimistic. However, we also acknowledge as a care provider, that we operate in a sector with ever-increasing demand for services and limited funding. This means we’re coping with rising numbers of clients waiting for a care package in their own home or waiting for a nursing home placement.

We’re clear, though, that continued integrated working is vital to the maintenance of excellence and the provision of seamless health and social care. Challenges and solutions can be overcome by all to ensure that people’s changing health needs are met if partnership working across the sectors is encouraged and adopted as the norm.

Our working group concluded and recommended that embedding new ways of working, and developing trust and understanding between organisations that work together to provide care is vital to successful health and social care integration.

We also agree with the NAO that integrated care should be entirely focused on the patient’s wishes and needs.

Kevin Fairman is Chief Executive and Sandra Payne is Head of Clinical Excellence at Brunelcare. Email: kevin.fairman@brunelcare.org.uk sandra.payne@brunelcare.org.uk Twitter: @Brunelcare

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