Wednesday 17 July 2013

Why Andy Burnham is Right about an integrated Health and Social Care

This rather excellent article in the Telegraph of all places, bravely tackles the real issues facing the NHS, free from spin and political point scoring.

It highlights Andy Burnham's driving passion to integrate Health and Social Care in the UK. A genuine perusal of the OECD health stats released last week make challenging reading for proponents of both private and public healthcare. There are no easy answers neither solution offers a golden promise of a better tomorrow. What shines through however, as Mary Riddell rightly points out, is that the NHS does what is does remarkably well for less money than most developed nations. Not even in the Top 10 for Health spending, with fewer hospital beds and staff, the NHS manages to be the most equitable health service in the world and one of the most efficient.

How has the NHS pulled off this extraordinary challenge, repeatedly through decades of underfunding and ill thought through "reforms"?

It can only be attributed to the unfailing loyalty and support shown by staff and patients alike. We WANT the NHS to succeed. We work harder, cram in more and at times seem to pull off a miracle close to feeding the five thousand with a few loaves and fishes.

Burnham's plan to integrate Health and Social Care might just be the salvation the NHS has been creakingly waiting for.

Academics and politicians will no doubt argue the merits and drawbacks of the idea and according to Riddell, the main objections from the Labour front bench is cost.

As a patient and soon to be Social Care user, perhaps a little real insight from one at mercy of the status quo might help.

Imagine living with a long term health condition of disability that requires regular and expensive healthcare interventions. There is a pattern, and excuse me if I focus on what I know best - long term illness.

You are well for a while. Or at least not as grindingly unwell as usual. you manage fairly well alone, doing all you can to avoid hospital and incapacity. But as symptoms worsen, you are often left utterly stranded. Not quite ill enough yet for the endgame of in-patient care and possibly surgery or intensive treatment, you are not well enough to cope at home.

So begins an endless round of interviews, assessments, more interviews, financial analysis, endless forms and a permanent place on the end of a phone trying to navigate the endlessly frustrating maze of possible support.

In my case, I've never actually managed to arranged help from social services before my health has descended into crisis and I join a waiting list for acute care.

Once the NHS has picked up the pieces, thousands and thousands of patients spend weeks longer than necessary waiting to go home or the halfway house of a convalescent home or residential care. A recent study showed the average wait for an elderly patient is 28 days. 28 days of unnecessary bed blocking, unnecessary in-patient care and frustrated lives.

Now imagine that as your health deteriorates, your consultant can contact the local social services, arrange necessary care and support easily and quickly, based on need - and above all - prevention.

A carer comes daily to help you wash or move about, to prepare a nutritious meal and ease the burdens of running a home and possibly a family. You have the chance to rest, eat well, someone helps you to manage and access treatments from home that would otherwise involve a hospital stay and with a little luck and some genuine support you avoid crisis altogether.

If the two systems become one, they can communicate more efficiently. Their budgets will be intertwined, so prevention becomes as important as cure. At my last hospital, a team of specially trained bowel nurses would be able to arrange high level interventions from home, supported by a district nurse, but all too often the process took far too long.

Far too many vulnerable patients become in-patients for want of the correct support at home. Chronic illness and mental health conditions will become by far the biggest burdens on 21st century health around the world and in so many cases, this need not be the case.

Currently, with local authorities facing eye watering cuts of over 25% over the course of the parliament, social care has been cut back drastically, with many cutting "moderate" care needs altogether. However, as campaigners have argued, for all the reasons I list above, this is a totally false economy. Needs that were "moderate" (and therefore less costly to the taxpayer) soon become "substantial" or "critical" through neglect and the only place left to turn is the NHS. The pointless waste is heartbreaking as almost anyone actually at the mercy of the system could tell you.

Our entire emphasis (and indeed, the emphasis of all healthcare systems around the developed world) needs to shift from cure to prevention. Any reform will only succeed if this is the case. Obesity, smoking, drinking alcohol, increasing long term illness and mental health crisis ALL reduce with efficient and genuinely enabling support structures.

So my message to the two Ed's is Burnham is right. His plan to integrate health and social care could genuinely revolutionise the way we treat our population, saving billions in pointless interventions and unnecessary and traumatic in-patient stays. We don't just need to consider his plan, we need to stretch every sinew to make sure that it comes into being. Only by reversing the swingeing cuts to care can we re-balance the system towards prevention. The rewards would certainly be astonishing.


  1. It's already starting to happen. The Borough I work for has a Re-ablement Team (yes, I know it is a silly name!) which is responsible for assessing patients waiting to come out of hospital and then spends 6 weeks working with them in their own homes. Continuous assessments take place over that period. Often at the end of the six weeks, people are back on their feet and independent. If they aren't, then long term social care services are put in place. The borough has been doing this for the last couple of years with some success. If you want to boil it down to basic cost savings, less beds are being blocked, care packages are far better targeted and don't go on indefinitely after they are no longer needed.
    I work in social care and I feel the integration of health care and social care can only be a good thing. They do overlap and a combined approach would be so much more holistic.

  2. Thanks Toni, fascinating comment

  3. Very positive, thoughtful and sensible suggestions. Gives a very good guide how to produce more preferable, economical and effectual social and health care systems to provide beneficial treatment and on-going assistance to the people in this country.

  4. I used to be a social worker (now chronically ill and disabled, so I know both sides!) and whilst I do support integration in principle (as it would, if budgets were organised correctly, stop the age-old problem of health and social care fighting about who is responsible for funding what), it has to be done in the right way.

    Too often, professional roles become homogenised, which means the expertise of each one's training becomes lost, and professionals are expected to do things they were not trained to do.

    When I worked as a care assistant, I was present at the social care review of one of the residents, and it was carried out by a nurse who promised all sorts of things that could never be delivered, because she didn't know anything about social care.

  5. I think Mel makes a good point, and a truly integrated service can't be brought about just my merging the budgets. There needs to be some new combined training and perhaps some new roles (like the care co-ordinator role in mental health). The biggest problem is the doctors. They have an obvious leaning towards the medical and are very powerful. This needs to be addressed to ensure that social care is respected and not just there to facilitate the needs of healthcare.

  6. Social care is very much necessary and we need to focus more for public health. I think it is a nice idea to integrate health and social care.Destiny Ramjohn is also the person whom i know working for the same goal regarding public health awareness.

  7. As a former social worler in children and family services it has long been acknowledged that integrated working is far more effective in terms of time, cost and practise. However for this work both sectors have to be willing to work in partnership putting the service user at the centre as in childrens services. The silo mentality will prolong what seems to be a futile debate.

  8. aspergers parent is a free social network that care & Support for the Caregivers, eldercare, senior caregiving, senior helpers, aging parent and family caregivers.