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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee

 
 

2020health Roundtable Health and Social Care with Chris Skidmore MP

Oct 18. till Oct 18.

Further integration of health and social care

A 2020health roundtable discussion hosted by Chris Skidmore MP.

Date
October 18, 20102010-10-18T08:30:00 - October 18, 2010 2010-10-18T10:00:00
Time
8:30 AM 2010-10-18T08:30:00 - 10:00 AM 2010-10-18T10:00:00
Location
Church House, Westminster

These are the summary notes of a discussion that took place on 18th October 2010 with Chris Skidmore MP, member of the Health Select Committee. 2020health will be exploring health and social care integration further in 2011.

The objectives of this roundtable were to:

  a. Discuss social and healthcare integration, including public health, domiciliary care, personally held budgets and patient choice.
  b. Raise the key opportunities, lessons already learned, influencing commissioning, and the opportunities for meeting the needs of older people.

Attendees

  1. Ruthe Isden, AgeUK
  2. Richard Jones, Association of Directors of Adult Social Services
  3. Steve Bates, Genzyme
  4. Priya Goyal, GSK
  5. Chris Skidmore MP
  6. Alan Maine, Pfizer
  7. Mark Jackson, Saga Independent Living
  8. David Walden, SCIE
  9. Prof David Croisdale-Appleby, Skills for Care
  10. Mark Weston, 2020health
  11. Julia Manning, 2020health
  12. Eleanor Winpenny, 2020health

Event Summary

 

Introductory comments from Professor Croisdale-Appleby

Benefits of integration of health and social care for which there is an evidence base:

  1. Improvement of outcomes
  2. Professionalising those who work in social care
  3. Saving money

Example project:

Training residential social care workers to undertake some of the roles of physios and nurses in North Somerset.  The aim was to enable delay of the transfer into long term nursing care.

The project challenged professional divides, but after 2 years health and social care staff were working well together.

Outcomes included:

  • Reduced hospital admissions
  • Serious illness was spotted earlier
  • Good feedback from patients and their families
  • Increased job satisfaction from social care staff
  • Improved relationships across the health and social care sector

A by-product of the project appeared to be that more people were attracted into social care careers.

This kind of project can be scaled-up across England.  The scaling up of projects is very important for sustainable and widespread benefits.

Discussion

 

Funding

Funding for social care is going to be very tight in the future.  25% cuts are anticipated (this was 2 days before the CSR), along with increasing numbers of elderly people who will need care. It was previously thought that £400million from the NHS would be allocated to social care, but this is now not going ahead. The ring-fencing of the NHS has created an artificial division between health and social care. Although both will have difficulties with future funding, social care will be harder hit. It makes no sense to have this divide when improvements in social care would reduce spending on healthcare.  One possibility where funding can be used jointly for both health and social care is when personal budgets are allocated.  The future extension of personal budgets may lead to a more joined-up care with the patient at the centre*.

 

Social care is needed as an alternative to acute admission. There are too many hospital admissions currently, but this is partly due to lack of other resources to deal with those who need care.  GPs should be able to prescribe domiciliary ‘acute’ care*, crisis support, re-ablement programmes, telehealth*.

However the current lack of funding in both the NHS and social care may be a blessing in disguise.  A catalyst is often needed to drive change, and a lack of funding, and the need to look for new ways to save money may serve to drive this agenda.

Communication and Education

Communication of what resources are available is one of the main problems.  Many health care practitioners, including GPs have little idea of the services available in social care for their patients. There is a need to concentrate on educating clinicians on what is available in the social care realm as well as educating the public. New doctors are the easiest to access and it would be useful to insert a module on social care into doctors training*.

Communication with the public needs to be done at a local level.  This is due to the different demographics meaning that different methods of communication will be appropriate in different areas. Connected Care Centres can be useful in communicating what is available to the local population.  They allow one point of call for all services and employ people who live locally. 

Opportunities created by the current NHS structural changes

The current changes underway in the NHS create various opportunities for bringing health and social care to work together more closely.  GP commissioning may create opportunities for GPs to be involved with commissioning both healthcare and social care.  This will depend upon the methods of operation of different GP commissioners and will become more clear as we move forward. Under the new model, GPs will need to take responsibility for their patients on a continual basis, not just when they visit the surgery, and in this they will need to work with social care.

The opening up of the NHS to ‘any willing provider’ may also provide opportunities for companies that offer both health and care services. At the moment domiciliary care is 90% delivered by the private sector. Furthermore, public health is to become a higher priority for the government.  Public health has strong links with social care, so this may serve to bring health and social care closer together

Value-based pricing

The current discussion around the definition of ‘value’ in value-based pricing will benefit from the integration of health and social care.  For example we need to ensure that pain-relief medicines have as high a value as life-extending drugs.  NICE and SCIE will need to work together, as they have done for the production of the current dementia guidelines, in order to look at the value of different kinds of outcomes*.

Getting people from health and social care to work together

The differences between health professionals and those who work in social care, the latter who do not have professional bodies, make it difficult for a sense of equal status. There is a feeling too that social care has not been bold enough to impose itself into health structures.

To make these changes come about, the separate systems for health, public health and social care will need to be aligned from the top. This could involve including representatives from all 3 sectors on the NHS commissioning board.  As mentioned previously NICE and SCIE will need to work together, to build the full care pathway into any guidance produced.  Other ideas include paying GPs to do a social care assessment for their patients or training those who work in social care to recognise early symptoms of health problems*. These social care practitioners could then start treating the condition with soft interventions, that may be less intimidating than a visit to a doctor.

Scaling up of projects

Whilst some projects, such as that by Professor Croisdale-Appleby are successful, these projects will need to be scaled up to have a more wide-spread effect.  The movement away from a top-down organisation that drives generalisation, will mean that new ways will have to be found to allow transmission of best practice between localities and drive change. One method of doing this is to submit project proposals to local enterprise partnerships which may then chose to take up the project.