Whenever anyone talks about the integration of health and social care – they prefix their opinion with – well if you were planning for an integrated system – you wouldn’t start here! Indeed, that is most definitely the case, however, the harsh reality is that if you need to move between health and social care today – this is exactly where you have to start. We are deeply entrenched in a silo based set of systems that doesn’t encourage the flow of information or people between organisations, and in some cases, actively prevents it. In recent months, following the direction of central government, the Care Quality Commission have embarked on a series of locality reviews, which bring together information on how the health and care system is operating in situ. Towards the end of last year they produced an interim report on their findings, and whilst there were pockets of reasonable practice, the overwhelming impression was one where the hatches remain well and truly battened down, and the warm words of integration have yet to make a marked impact. Of course, we are in an era where it is not just warm words, but the integration agenda is backed up by hard cash in the form localised pooled resources through the Better Care Fund. However, the boots on the ground do not appear to have received the dispatch.
Or is that pessimism unwarranted? The winter discharge figures for 2017/18 appear to show a significant improvement in the numbers of delayed discharges caused by lack of access to social care. If this shift is to be realised and maintained, how do we capitalise on what is working to make sure we learn the right lessons. There are a number of very positive examples that have been implemented in different localities that appear to be making a difference, and the opportunity to share this learning cannot be missed. The first of these areas is ensuring that the person moving from the care system to the health system is supported by the right information about them. The most well-known approach to ensuring this has been the Sutton Red Bag scheme. This scheme, born out of the NHS England Vanguard programme, using the a physical prop of a red bag to enable care home staff to include all the critical paper work and information relating to an individual in one place, and to ensure that it was all returned safely with the person on their return home. A simple concept that has gained traction, and is being mirrored in other areas of the country.
Other models of person centred information flow include the innovative My Care Matters. This approach has evolved over a number of years, and Zoe Harris, the designer of this system explains “it is well understood that knowing about the whole person and not just their medical condition leads to a better standard of care, and that an holistic approach can reduce the average length of stay: reducing costs and improving outcomes.” My Care Matters enables the personal profile of an individual living with dementia to travel with them through the health and care system, and via the medium of a physical My Care Matters profile chart, or online version, that clearly states the likes and dislikes of an individual, it is possible to ensure that everyone who interacts with that individual in a hospital setting has a good understanding of who they are – putting the people part of person centred care on view.
The opportunities for technology to play a key part in supporting effective integration between health and care are, of course, very much on the agenda. WCS Care, an NCF member, has been working in close partnership with South Warwickshire NHS Foundation Trust. They have just got to the end of the first year of a partnership between the two organisations based around an integrated approach to admissions from hospital into the care home as part of a ‘Discharge to Assess’ scheme. There have been 265 people who have been supported over the year, and the results are impressive. Key components of the success of the scheme have included a 1.4 hour average turnaround time by the care home to confirm assessments, 94% of patients discharged with no night time needs, 79% of patients discharged as self-medicating, 89% of patients discharged to their usual accommodation and very importantly a view that with greater efficiency in the integration of health and social care – patients could return on average 4.6 days earlier than they currently do.
So, as the sun shines down on the rest of the country, those inside the health and care system will be already thinking about the winter pressures ahead. It is hoped that the positive examples of people centred integration will give them hope, that there are viable and positive options for transforming the integration debate.
Vic Rayner, Executive Director, National Care Forum @vicrayner