'NHS funding gap is preventing an integrated health and social care service'
Tim Barclay, CEO of Appello, talks to Care & Nursing Essentials about why the Government needs to follow through with promises to integrate health and social care.
"With a wider remit, and a new job title following the latest cabinet reshuffle, the Secretary of State for Health and Social Care Jeremy Hunt has the unenviable task of finding funds to plug large holes in both the NHS and social care budgets. While we do not yet know how the newly formed Department of Health and Social Care will arrange its funding pools, but there is no doubt that he will need to find a significant amount of funding to relieve current, and future pressures – with some estimates at around £2.5bn by 2019-20 for social care and a further £30bn by 2020/21 for the NHS.
"Keep those figures in mind when you also consider our ageing population – the number of people aged 85+ in England has increased by almost a third over the last decade and will more than double over the next two decades.
"The formation of a combined health and social care department is the clearest sign yet that the Government is committed to an integrated health and social care service – but talk to most at the coal face of health, care and housing for older people and you will find that the reality is slightly different.
"Recently, we hosted a panel discussion with representatives from the Better Care Support team, the Association of Directors of Adult Social Services, Mears Group, Housing & Care 21 and Independent Age. The discussion asked how we, as a combined ecosystem responsible for the care and support of older people, will tackle the challenges ahead and make sure older people do not fall through the gaps between departments and funding pots."
Is the integration of health and social care really happening?
"There is still much confusion over who funds services, and where to turn for health and social care when it’s needed. This is a view echoed by Alan Mears, Chief Executive of Mears Group, whose care teams provide support to around 300,000 people a year: 'There is still so much ambiguity around what integrated health and care actually means. Are we integrating services, data, technology or organisational structures? There seems to be a real lack of joined up thinking and good examples of integration across the sectors that can be scaled. How can you draw a line between people receiving a health service or social care? We should not be having a debate about funding or who pays. Is this an NHS or social care bath? These services should be integrated with funding coming from the same pot.'
"Margaret Willcox, the President of the Association of Directors of Adult Social Services (Adass) held similar views: 'The fundamental problem between health and social care is the funding. Access to healthcare, through the NHS, is on the whole universal, but adult social care is funded through eligibility criteria. Indeed, changes to self-funded care now means those with more than £23,250 in capital are required to pay the full cost of residential care, so people will pay for their own care as they age. When you add in housing to the other two funding streams it becomes even more complex because social housing has its own eligibility criteria. Some of our predecessors have concentrated on integrating structures, but that is almost impossible; what you actually need to do is integrate practice.'
"I wholeheartedly agree with the original reasons the Government pushed for integration – that we need to put the individual at the heart of the care pathway. What I believe is missing is a decision-based metric that genuinely finds money from available resources irrespective of where that might be. At present, there seems to be little proven practice of a system that can arbitrate across those funding pots."
Who will fund integrated health and social care?
"Considering for a moment that the Government does manage to integrate services effectively, there is still some question over where the extra funding will come from as Janet Morrison from Independent Age outlines; “It’s clear that the Government needs to be more honest about funding. We cannot keep up the pretence that if we all work a bit harder in health and social care then we can make it work. The Government must start a public debate that addresses the funding that will be needed by individuals to fund their care and support in older age, and what is available in terms of funded assistance. When we come to fund this as individuals, I think we need to look at whether social insurance is the answer.
"The concept of individuals taking more responsibility for their own old age care is something that comes up again and again as a solution to the current funding crisis, but as Matthew West from the Better Care Support team mentions, the rhetoric needs careful consideration if it’s to be sold to a public, already feeling the pinch. Mathew believes the Government must position it in a way that the public sees the value and that it must be looked at as an insurance, rather than an additional taxation, and the conversation must be about how the Government will share the care, health and housing risk with the public."
How can technology help reduce the financial weight on the public and Government?
"We know that the task ahead for those responsible for looking after our older population is going to be a difficult one – the funding gap figures speak for themselves – but there are some changes that can be made now to improve efficiency.
"We have to start spending the money that we do have in smarter ways, to benefit those in need. I feel frustrated that technology is not being used more widely to fill the glaring gaps in funding and to better understand the needs of older people. This is a view also held by Alan Long from Mears Group, 'I think we must look at how money is already being spent. Can we make savings, by utilising technology and integrating it better with other services – I think we absolutely can.'
"We also need to break down the outdated perception that older people will not want technology. If you can look at the benefits delivered in terms of lifestyle and safety we have found that they really see the value. Housing & Care 21 is a housing provider keen to also break down this perception and has been on a drive to provide its residents with the digital technologies that will benefit their everyday lives from a safety and social point of view, as Bruce Moore their CEO explains: “We need to overcome the assumption that older people will not adapt to using technology – if we can demonstrate the benefit with the technology as the enabler of improved quality of life or particular benefits, then our experience is that it is very well received. But there is still a tendency to view technology the same way as we view care workers – it’s at the bottom of pile. Many personal alarm systems are straight out of the ark. In an emergency, an older person pulls a string and a stilted conversation ensues. So, having the right technical infrastructure in place is crucial.
"'We have already introduced digital care systems that are allowing older and vulnerable people to live much more independently within assisted living developments – this means that on the whole they are not in acute care and are proactively being monitored so that trigger points to other long-term conditions can be identified sooner.'
"If we think again about how we are going to collectively manage the funding and availability of health and social care for older people, technology has to play a significant role in making care more effective and affordable, while keeping many more older people within their own homes, living independently, safely and happy for longer. And, it’s not just about the technology, the data generated is equally important. If we can collect and analyse data coming in from smart devices we can proactively help older people to stay independent, and out of acute care, for longer.
"But, there needs to be honesty from those delivering services whether health, housing or social care, and from the Government, about the changes that need to be made so that health and care can be delivered to those that need it."