Finally, the penny drops… health and social care are better together!
Jeremy Hunt has been made the Secretary of State for Health and Social Care, and whilst much of the instant reaction has been around the Health Secretary himself and the winter NHS crisis, and the political strength or otherwise of the Prime Minister, I’m far more interested in the implications of this newly titled position. There was previously a junior ministerial post at Health covering social care, but changing the name of the department is a huge signal about the future emphasis of the work.
The benefits of looking at an older person’s health and social care needs are clear. If an older person continually goes to the doctor with conditions that just don’t seem to improve, the doctor may not know that this person is having to make daily choices on heating their home or buying food. Similarly a social worker may find a client confused or unsteady on their feet, not knowing that the GP has changed their medication.
In the first case, a welfare benefits check could bring the older person more income, meaning that they can heat their home and eat properly which will improve their wellbeing and their resilience to illness. In the second case, the social worker can instantly report back to the GP and the meds can be reviewed straight away, rather than waiting for the next GP visit or worse, a crisis.
These are slightly crude examples but they illustrate the benefits of joined up working.
The Health and Social Care Act promoted the concept of integrated working between health and social care, but the problem here was that this has been done in a piecemeal way, with different models and methods of working adopted by different local authorities and clinical commissioning groups across the country, many involving local Age UKs. Social prescribing projects and integrated care models have been piloted, but with varying degrees of success and buy-in – perhaps this new Secretary of State role is an opportunity to really embed this idea?
However, if it is going to work then I think there are 3 areas that need serious work:
Motivation and Resourcing
If this is just a cost cutting exercise then not only does it demean older people, but it is doomed to failure. In the short term, integrated care will need resourcing properly, by which I mean spending on recruitment of quality frontline staff, and training. Ultimately it should reduce health and social care interventions (and save money) by getting the right care to the right person at the right time, preventing the escalation of minor issues into crises, and allowing them to stay healthy and independent for longer. But unless it is done properly it will create a low-skilled, unmotivated workforce, operating in a bureaucratic mess – and those who will suffer most are the older people.
It is bizarre and almost inconceivable that in 2018 there is no single IT health and social care platform in use. There is not even a single platform used in local authorities, or a single one in health – there are many, and some of the systems don’t even talk to each other.
If health and social care integration is going to work on the ground then it is going to mean that multi-disciplinary teams have the ability to share client/patient data between professionals in real time – and we have the technology! But without a common platform that puts the older person at the centre of the work, professionals on the ground will have to deal with duplication and miscommunication, and the older person will be the one who suffers from the confusion.
The problem here is that large scale government IT procurement does not have a happy history…
Culture and Leadership
In the paragraph above I used “client/patient”, which illustrates the cultural divide between health and social care – a social worker will say “client”, a nurse will say “patient” but they are talking about the same individual. Even when the same phrases are used, there are issues – “safeguarding” means different things depending on the social care or health context.
Does this matter? Well, yes because it illustrates some deep-rooted ways of working – if this is going to work it will need visionary leadership, strong communication and constant reinforcing from Jeremy Hunt.
By the way…
It’s worth mentioning at this stage that if the new Secretary of State for Health and Social Care wants expert local staff and volunteers who have a good all round knowledge, a caring attitude and who put the needs of the older person at the heart of their work, then he doesn’t need to look any further that those charities who work with older people in the community – and local Age UKs across the country are already doing this work every day. Just saying . . .
And so whilst I think this new emphasis on social care as part of the health remit has huge potential to really bring some dignity and quality care to older people, it’s fair to say there are some huge issues that need tackling.
Over to you, Mr Hunt.