Integrating health and social care – the blend of the best
Featured article -
31 March 2017
David Pearson CBE, Corporate Director, Adult Social Care Health and Public Protection and Deputy Chief Executive, Nottinghamshire County Council
With all the investment over the last few years in vanguards, new models of care and Sustainability and Transformation Plans (STPs), it is time to take stock and reflect on what we are trying to achieve. We know that health and social care integration will not in itself save money or improve outcomes. But in a world where increasing numbers of us are living with a disability or long term condition we need joined up services to better meet our needs, improve our health and wellbeing and maintain our independence. For those who need it there must be proactive, person centred and coordinated care.
This is why I welcome the research by SCIE for the Department of Health on integration 2020 and the strong and ambitious focus in the policy guidance on integration. Because integration is more important than ever.
Certainly this view has been reinforced in my role as STP lead for Nottinghamshire. Local citizens have told us that they want services that are seamless, where you don't have to tell different health and care professionals the same thing over and over again. It is clear from SCIE's research that these views are mirrored nationally. People want to feel that they are getting one coordinated service.
But getting there is not easy and progress, as the National Audit Office report argues, is slow. What do we need to focus on? Firstly we need to work as a single leadership team across the whole system - health, social care, care providers and housing - with a clear vision for what integration means for the whole population
Secondly we need truly integrated teams based in communities which work across organisational boundaries to deliver person-centred and co-ordinated care. This is one of the primary aims of our STP. In mid-Nottinghamshire the health and social care system has successfully established Local Integrated Care Teams, whereby social care staff work alongside a range of health professionals to identify and support citizens at greatest risk of hospital admission. Staff in these teams have a much better understanding of each other’s roles, are improving people’s experiences of care and reducing non-elective admissions to hospital.
Thirdly, we need to involve citizens from the start when we are designing and changing integrated care services - citizens often have the ideas and solutions we won't have thought about. But we don't do this enough at present. Finally we need to focus relentlessly on what matters to citizens. We need to start with the outcomes that they want.
By working together, in Nottinghamshire, we have seen lower levels of delayed transfers. At Nottingham University Hospitals we have introduced a ‘cluster’ model whereby social workers are identified as the named care coordinators for clusters of wards. From the moment a person is admitted, the social workers are responsible for establishing and meeting potential care needs after discharge as quickly as possible, in conjunction with the multi-disciplinary team.
For the last ten years at least we have worked to deliver better integrated care. That has been the right thing to do. We must not see integration as an end in itself; it is a means to an end. By 2020 we must have got closer to delivering this vision.