Julia Ross is the Chief Strategist for Care and Health with PredictX. She is a former nurse and social worker and is an expert on the TechUK Health and Social Care Council. Read more for her take on current challenges for health and social care transformation:
In the interest of the recent drive for greater integration between health and social care, three interrelated thoughts come to mind: the recent progress in reducing Delayed Transfers of Care (DToC), the lack of progress of health with social care integration and the current lags we face in pulling together relevant patient population data. These three elements have a single element in common – they all have the technology they need for transformation. The only factor that is not quite as certain is the will and ambition to take the next step.
1. Delayed Transfers of Care (DToC)
The recent progress in reducing the overall level of Delayed Transfers of Care (DToC) is laudable, especially in the face of limited public funding. As of August 2018, the Association of Directors of Adult Social Services found the number of delayed days in adult social care fell by 187,864 in the last year alone.
Even with this promise, we still cannot ignore that there are unnecessary delays taking place – amongst 144, 267 patients as of September 2018 to be precise. Our goal of improving the lives of older people is not being met as long as patients are unnecessarily stuck in their beds.
Glen Garrod, President of the Association of Directors of Adult Social Services celebrated the success of the reduction in the latest DTOC figures, published by NHS Digital last week. He was, however, critical of this government’s failure to provide anything other than sticking plaster solutions to the funding of social care– increasing the need for more innovative solutions to cope with this problem.
The main reason for Social Care DToC delays in September 2018 was “Patients Awaiting Care Package in their Own Home” and accounted for 15,500 delayed days which is, effectively, 35.3% of all Social Care delays. The number of these cases are rising steadily since April 2014 – reaching a peak in December 2016. They continue to rise by 2.2% since September 2017.
Why are these numbers increasing? The main culprit is the ever-problematic dilemma of increased demand with simultaneous cuts in funding. Health and social care systems are finding that, when we allocate resources to one part of the system – squeezing hard – the problem only seems to pop up in another place.
As much as we are concerned with reducing pressure on hospitals, we must not forget the primary reason these systems exist – to improve the quality of life for both ageing citizens and their families. Older people don’t fit into one specific category or another, they live in social, family and community settings as well as health systems. Their increasingly complex pathways cross boundaries in a constant flow between hospital, community, health and social care. It is a complex jigsaw and not one we can easily solve.
If you want to know more about current figures on DToC and how we can address it, read more.
Integrating health and social care is one way of connecting the dots between health and hospital and the daily quality of life for our citizens. Unfortunately, there is a long way ahead until this is achieved.
2. Integration of health and social care
The recent Public Accounts Committee (PAC) reported that the government is still “a long way” from achieving an effective strategy for integrated health and social care. They are focusing on creating a ten year plan for integrated care alongside the NHS’s own ten year plan. As integration becomes adopted into future planning, we hope more success will follow.
While there has been some recent progress on these fronts, this has largely been in relation to the NHS only – the Vanguards and ICS largely focused on improving health integration across the acute and community sectors, rather than looking at the whole system including housing and social care.
Next year marks the 20th anniversary of setting the objective to ensure better joint working between health and social care. The objective was first set in the Health Act of 1999. Two years later in 2001, I became one of the first Directors of Social Services to take on the joint role as Chief Executive of the local Primary Care Trust in Barking and Dagenham. We worked hard, especially with the local GPs, who were at first suspicious and then gradually saw the value as we reduced DToCs from around 100 a day to a much more acceptable three or four. The patients liked it, the GPs certainly did and the nascent Health and Wellbeing Board happily took some credit, however, after three years of progress, the project was abandoned due to challenges arising from integration with the local, acute hospitals.
3. Bring on the data! It’s time to pull health and social care data together
Why is it taking so long to pull together all the relevant patient and population level data? Such data is needed to support forward predictive planning, both at individual and whole population level.
Now is the time to try again. With improved technology, artificial intelligence and the ability to easily integrate the data – both at a patient level and a financial level – we are able to tell a daily, digital story of older people and their care across all services.
Matt Hancock, the new Secretary of State for Health and Social Care, recently announced the release of: The Future of Healthcare: our vision for digital, data and technology, October 2018.
“We have the opportunity to create the most advanced health and care system in the world, and to become the global leader in healthtech. By harnessing the power of technology and creating an environment to enable innovation, we can manage the growing demand for services and create the secure and sustainable future for the NHS and social care system that we all want to see,” wrote Matt Hancock in The Future of Healthcare: our vision for digital, data and technology, October 2018.
A core pillar of strategy is to empower citizens to manage their own health. Prevention is better than cure. This mantra is leading current movements in health and social care forward to a place we have been previously been hoping for – personalised care for the individual. We will know we have achieved our goals when each individual can have easy access to their GP, social care workers have all information on each case or patient at their fingertips and developers and researchers have easier access to the data they need to work with to develop new solutions for the NHS. Citizens over 85 suffering from DToC may not see the change in their lifetime but change is most certainly coming.