Jeremy Hunt’s speech outlining the seven principles for reforming social care was most welcome after another winter of discontent in the NHS. The speech recognised that much of the pressure on the health service is brought about by problems in transitioning patients back into their homes and communities, an issue the Royal College of Occupational Therapists (RCOT) has been talking about for a number of years. The crux of the challenge lies in how to better align health and social care and how to change perceptions of social care so it receives parity with health.
Serious, sustainable investment in IT
First, let’s focus on the patient, as per Hunt’s second principle. It seems obvious but it’s where the NHS is getting lost.
One of the greatest barriers to patient-centred care is the vast array of IT systems carrying relevant information across the two sectors. Anecdotally, we hear numerous stories about how patients have to repeat their medical and treatment histories as they are referred across services.
Where does this leave patients who are confused, anxious or with a history of self-harm? Vulnerable and more confused; unsure of who they are speaking to and uncertain that they have been heard. Staff are also in the dark; the patient in front of them is a blank canvas about whom they have no prior knowledge. They have to spend time trying to trace records and understand previous treatments. Empathy and trust between patient and professional must be built repeatedly from scratch.
Imagine that health or social care professional had their patient’s history. They would know something about the person and immediately understand why the patient was referred to them. They could quickly establish a rapport, assess the patient and, most importantly, swiftly deliver the interventions needed. Trust is maintained between patient and professional.
When we consider this issue in the context of the millions of people in the NHS system, we can begin to understand the volume of time wasted in health and social care. We need serious, sustainable investment in an IT system that serves both sectors and that patients can access. This is not a “nice to have”, it is a must for the future of our health and social care system.
Care is not just about doctors and nurses
Second, we need to remember that people don’t live in hospital, they live at home. At present, the medical approach to care undermines the patient-centred focus the NHS seeks. In recognising and assessing the person, as opposed to their condition or illness, health and social care can combine for a holistic approach that supports an individual’s return home as quickly as possible.
The traditional approach focuses too much on acute and primary care issues in the NHS: waiting times, lack of funding, shortages of doctors and nurses. The broader – and, crucially, potential – scope of the rest of the health and social care service is overlooked.
Not all health and social care professionals are doctors and nurses. In addition to 106,430 doctors and 285,000 nurses and health visitors, there were 158,000 allied health professionals (AHPs) in the NHS in March 2017.
The RCOT has evidence of occupational therapists working with paramedics reducing admission rates to hospital from 999 calls as a result of a fall by up to 76% in East Lancashire. This represents a real-time saving of approximately £200,000 a year. If all 207 clinical commissioning groups in England made a similar saving responding to falls, £41m would be saved.
Sadly, such achievements often go unrecognised, and recognition and national roll-out of great initiatives led by AHPs become hard to achieve. This is just one example. How many others are there of AHPs contributing to excellent patient-centred care that demonstrates real value for money? I would guess hundreds, if not thousands. I’m not saying we don’t need nurses and doctors. Of course we do. But the answer to better care lies in better use of AHPs, not just in more doctors and nurses.
Harness the enthusiasm of staff
Third, we spend too much time bemoaning our greatest national asset instead of celebrating it. The spirit to fix the NHS and deliver a health and social care system that works for the future is there in abundance. What we now need is for Hunt and his policy team to better support us to deliver it.