Unblocking: Securing a health and social care system that protects older people

Author: Alex Thomson and Steven Howell, Localis   |   23/02/2015

Localis’s new report ‘Unblocking: Securing a health and social care system that protects older people’, published today, explores the failures of the health and social care system, which is resulting in sub-standard care for the older population. The study involved extensive interviews with local health experts, a survey of more than 100 senior local government figures and a number of case studies.

The report, produced in partnership with Anchor, addresses some of the recent issues witnessed in the health service, explores the reasons behind them and argues that recent changes need to go further. It argues that it is older people who are suffering the most from the lack of health and social care integration. They are more likely than any other age group to face unnecessary admissions to hospital, and to experience lengthy discharge delays and poor standards of care – problems that are only likely to be compounded by shrinking health and social care budgets. And these vital issues will become ever more critical as the population of England continues to age.

The report received positive coverage in the media, notably in the Daily Mirror and the Daily Express.

Key findings include:

1. The health and social care system still rewards activity, not outcomes, so undermining attempts to focus on the successful management of long-term health conditions.
2. In fact, we financially incentivise disjointed care with short-term budgets that inevitably end up being concentrated on short-term pressures in the system, rather than thinking afresh about how to prevent illness in the first place.
3. UK healthcare does not do enough to prevent avoidable injuries for older people and is conditioned to keep older people in hospital longer then they need to be there.
4. Relationships between partners delivering care remain poor.

The Coalition government has acknowledged some of these problems, and our research identified some glimmers of hope with positive examples of health and social care working together. It was revealing, however, that despite all the rhetoric, we found many on the ground believing that Westminster and Whitehall do not understand care for older people.

Our recommendations:

1. To shift the blame away from innocent patients by encouraging the media to stop using the phrase ‘bed blocking’ and use ‘preventable bed occupation’ instead.
2. To better co-ordinate care for the elderly by introducing single, placebased commissioning budgets for 40-55 year olds (who gain the most from prevention) and care provision of those over 85 (who are the most likely to have complex medical conditions). Also the introduction of a Minister for Older People will ensure that care for the elderly is better coordinated at Whitehall.
3. To reduce fragmentation of the health and social care system. Firstly by making acute trusts a statutory member of Health and Wellbeing Boards to foster local relationship building and secondly by fast tracking a best practise accreditor to highlight innovative ideas for integrating health and social care.
4. To provide budget stability and allow for long-term strategic planning by the next Government committing to a fixed five-year budget. The Government should also review the wider funding mechanisms and set a five-year timetable for complete NHS Tariff review.
5. To increase the flexibility of primary care by ensuring that technology and innovation are supported and well documented serving as an example for local areas across the country.

Support for the report:

Rt. Hon. Alan Milburn
“This important report sets out useful proposals to address the problems faced by our health and social care system. It is welcome that the notion of integrating services around the needs of patients and citizens is fast becoming a new orthodoxy in public policy thinking.”

Paul Burstow MP
“This report makes an important contribution to the debate about joined up care. If we are to break the log jam and ensure older people get the right care in the right place at the right time we need three things. We need a long-term funding commitment, we need a single pooled budget and we need a common purpose. Focusing on promoting people’s wellbeing so they can get on with their daily lives should unite the NHS, social care and housing in a shared endeavour.”

For any more information on this publication, sponsorship or media enquiries, please email jack.airey@localis.org.uk.