Alison While
The increasing older population should be a cause for celebration as it demonstrates the success of public health and medical advances. Yet, there is a realisation that things cannot go on as before if the demand for support in the home is to be met. The Government has announced an additional £650 million for adult social care in 2019/20 with plans to inject an extra £3.5 billion a year into primary and community healthcare by 2023/24. The Social Care Institute for Excellence (SCIE) (2018a) argues that the £650 million, together with any existing money, should be invested if there is evidence of effectiveness in preventing or reducing the need for care or improved care outcomes, rather than unquestioned continued funding of existing services.
SCIE (2017) demonstrated how Birmingham City Council used the whole systems approach to foster innovations helping older people and people with disabilities to build a ‘good life’ where they lived, but this promising approach is yet to be implemented widely. The Shared Lives and Age UK Living Well services are widely recognised, to which Birmingham City Council has added local area coordination, social prescribing, extra-care housing as well as extra support for those leaving hospital etc., to yield a £7.5million annual saving on adult care. Social care discharge coordinators were introduced, Royal Voluntary Service personnel identified older people who might need support on discharge, and British Red Cross Support at Home volunteers helped people with long-term conditions regain confidence and independence after hospital discharge. SCIE (2018b) uses case studies to illustrate scaling up of these innovative models.
Disappointingly, Round et al's (2018) evaluation of a well-funded integrated care programme for a population of over 400,000 in London found that the programme had not resulted in the planned reductions in hospital admissions or nursing home usage, although service integration did improve. This evaluation highlighted the importance of setting realistic goals, together with strong clinical leadership, shared ownership, in-built quality improvement and ongoing evaluation. SCIE's report for the NHS Leadership Academy (2018c) also emphasised the importance of leadership at all levels of organisations, with ongoing development to build the skills and qualities required to overcome challenges in system efficacy.
The Care Quality Commission (CQC)'s annual review for 2017/18 (2018) reported that most people (70%) in England experience good care, with quality ratings maintained from the previous year. However, some have poor access to care, and experiences vary across locations and services. Despite many older people moving between services to meet their multiple or complex care needs, examples of good joined up or integrated care remain infrequent. The CQC noted that sustainable person-centred solutions to meet the needs of the local population remain largely elusive despite widespread recognition of the imperative of transforming current service delivery. The continuing financial challenges may be mitigated in part by extra government funding, but the recent troubles of Allied Healthcare warn of the fragility of the current system. The time for continuing as before is passed; the need to implement models of proven effectiveness is urgent.
‘Many older people move among services to meet multiple or complex care needs, but examples of good integrated care remain infrequent.’