The approach to care must change. With an increased focus on health and, especially, social care, now is our chance: to not only ensure the current system works how it is supposed to, but also to realise a longer-term vision of what it should do.
The British Red Cross envisions lives being made better if three key elements of care are realised: care must be person-centred, preventative and integrated.
This is not too idealistic. The Red Cross has been providing health and social care services since before the NHS was established and have witnessed much bigger transformations.
Our system often fails to look beyond a person’s condition or illness. As pressures have grown, there seems to be less time to centre care on the individual.
The fact that more people are living longer, albeit with increasingly complex conditions, is testament to how far we have advanced medically. But our care system is lagging behind – way behind. We know how to keep people alive, but we have not yet mastered how to keep people living well.
When our volunteers and staff meet our service-users, we ask them what they want us to help them achieve. Most want help managing day-to-day activities or improving social networks and friendships. The importance of non-clinical interventions should not be underestimated.
We spend time with them, often in their own homes, earn their trust. As such, we are able to identify seemingly small interventions that could have a huge impact on their health and wellbeing.
We might learn, for example, that somebody is not sleeping well because they cannot remember who they lent their spare key to and are now afraid. A new lock could make all the difference. Other times it’s a small home adaption, a wheelchair, or help managing finances so that the heating is not cut off.
All of these interventions help to prevent a situation from escalating. They could be the difference between living independently at home, and being admitted to a care home or hospital. Despite this, the NHS Five Year Forward View largely overlooks the potential of non-clinical support.
Non-clinical personnel could also play a bigger role within busy hospitals. Across the country, we work in hospitals, providing the emotional and practical support that others do not have time to do. We sit with disorientated patients, collect prescriptions to assist swift discharge and take people home who need a little bit of support but do not need to be in hospital. The scaling up of this sort of assistance could improve both patient experience and flow.
Few would disagree that prevention is better than cure. Nevertheless, our health and social care system largely focuses on reacting to crises, rather than preventing them.
The Care Act 2014 placed a new prevention duty on local authorities, and the NHS Five Year Forward View calls for ‘a radical upgrade in prevention’. The will for prevention is there. Yet in practice, it remains an afterthought.
Take adult social care. Preventative services have historically only been available to people with eligible needs. This means people have often already been required to have ‘substantial’ or ‘critical’ needs.
The Care Act set out to change this. Local authorities now have to consider whether people could benefit from preventative services before their eligibility is determined. In theory, this means people with lower-level needs are in a better position to receive help before their condition or illness spirals.
Unfortunately, this doesn’t always happen. Red Cross research found that the Care Act’s vision for prevention is not being fully realised. In fact, spend on prevention has actually reduced since it came into force.
With overstretched funds, local authorities struggle to meet their statutory duties, let alone invest in services that prevent, reduce and delay the need for care.
The Care Act’s ambition for prevention needs to be strengthened, and preventative care financially, as well as theoretically, prioritised.
As it stands, there is no individual entitlement to access preventative services, suggesting a preventative system is a nice-to-have rather than a must-have.
As we live longer with increasingly complex conditions, it's becoming more difficult to distinguish between 'clinical' and 'social' needs.
Doing so often results in no statutory agency taking responsibility for the person or service in question. At other times, only part of the person’s problem is dealt with, increasing their risk of falling back into crisis.
With the number of people aged 80 and above projected to more than double by 2037, bringing different parts of the system together is imperative: not only for the individual but for our system as a whole.
Multidisciplinary teams have successfully kept people out of hospital and closer to home. These appear to work best when they involve the voluntary and community sector, mental health, and close involvement of housing, police etc., alongside health and care professionals. These should be celebrated and scaled up.
While Sustainability Transformation Plans1 aim to escalate integration, more needs to be done to define and reap the benefits of integration. Do we mean joining up care? Pooling budgets? Or do we need to bring our separate systems together as one?
Learning from good practice
Learning from devolved nations suggests a legislative framework, as done in Scotland, may also need to be put in place, not least to prevent health further overshadowing care. And, health and social care budgets need to be fully integrated to incentivise both local authorities and the NHS to properly invest in prevention.
The vision is clear: care needs to be person-centred, preventative and integrated. We can learn from good practice already taking place and scale up what works. It’s not an easy task, but we remain optimistic.
The views expressed in this blog are those of the blog’s author alone and do not necessarily represent those of Independent Age. Independent Age is not responsible for the accuracy of the information supplied in blogs by external contributors.