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A Different Perspective: The Future of Care

Following the release of the Autumn Statement 2016, Paul Wilkins, occupational therapist and co-founder of health and social care decision support

tool company Desuto, looks at why investing in health and social care is more difficult than ever and how to tackle the challenges ahead.

By now many people will have heard that the Chancellor, Philip Hammond, in his autumn statement has ignored the overwhelming evidence and calls for increased spending on social care and that he also seemed to be oblivious to the state of our NHS.

As individuals we feel most passionate about the industry we work in, particular when the government seems not to understand the dire circumstances that they find themselves in.

In order to test out whether my bias was getting in the way of seeing the government’s big plan for health and social care, I carried out the 15-year-old-son-test. The scientific methodology was to sit my son down and to seek his conclusions to compare against my own.

I first asked, from his own experience of his grandparents’ care needs what basic help they required later in their lives. Having established this I then asked him what he thinks would have happened if they hadn’t been adequately hydrated or nourished, hadn’t received the correct medication at the right time, hadn’t had help with their hygiene, or hadn’t been helped to the toilet when they needed it and what if they hadn’t had social contact and someone to talk to?

His response was instantaneous; ‘they would have become ill and in need of more help.’

My next question then, was, if they became ill what would happen next? He quickly replied ‘they would need to see a doctor, perhaps call an ambulance and perhaps go to hospital.’

So once in hospital, what if they - 10 -

needed help when they came home but we weren’t around to do this, but neither was there enough care staff in the community to do it either? He hoped ‘they would stay in hospital until they could get the help at home that they needed.’ So, what if that help was took a long time? ‘They would have to go into a care home if they couldn’t stay in hospital.’ And what if the care home was full up? At this point he conceded defeat with some frustration and returned to his online game.

In Cornwall, where we live and work, it is estimated that on any day 60 people are in an acute hospital bed when they don’t need to be, and that 35% of patients in all community hospital beds are fit to leave but can’t. This points to a clear imbalance between health and social care provision, unless the two are complementary and in equal balance, one will always suffer for the relative success of the other.

In a recent survey conducted by The Association of Directors of Adult Social Services (ADASS) the national social care funding gap was predicted to rise to around £2.5 billion by 2020 if nothing was done to halt it. The pinch has already started with well over half of all Local Authority areas reporting home closures and providers handing back community care contracts, most likely because they simply aren’t economically viable for the provider.

So, in the absence of more funding from central government and the limited impact that predicted rises in Council Tax will bring, we all need to ask what we are going to do? In Cornwall and the Isles of Scilly we have just embarked on a period of consultation around a huge health

and social care reform plan. Taking control, shaping our future - Cornwall and IOS Health and Social Care Plan 2016 - 2021 is part of the Devolution Deal for the area and is a whole system reform of the sector.

The ultimate aim of the plan is to rationalise the whole health and social care system, to improve the health and wellbeing of the local population, and to improve the quality of health and care services whilst delivering financial stability. The plan has six strands including health promotion, integrated community care and transformation of urgent and emergency care.

Anyone who has worked in the sector for a while will be aware of the agenda to integrate health and social care and many would say this is well overdue. True integration can only be achieved through the combining of budgets, commissioning, expertise and management. There has long been distrust between statutory health and social care organisations caused, in part, by funding pitting one against the other - if someone can be funded under NHS Continuing Health Care, the Local Authority does not need to find money from its budget to support a particular individual.

If any integrated plan is to work, the decades of mistrust will have to be overcome and the crucial role played by health and social care, in equal measure, will need to be acknowledged and nurtured. An integrated system, solely coordinated by one or the other, will be destined to fail and will be perpetuating the already apparent imbalance between the two part of the system.

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