Tai Chi

When people live till 120, how will health and care services cope?

By: Vicky Sargent @vickysargent
Published: Wednesday, October 1, 2014 - 08:54 GMT Jump to Comments

You will be familiar with the figures on our ageing population, and the impact of the additional years of ill-health and dependency on health and social care services.

So am I, but when I heard a speaker at a conference last week open his presentation with ‘meet Linda, she’s 64 now, and she’s going to live till she’s 120, including 56 years of retirement...’ the scale and scope of what is happening hit me afresh.

56 years of retirement? Maybe half of them in high dependency ill-health with multiple long-term conditions to cope with? Linda’s long life, speculative of course, but based on real data that predicts that some people living now will survive six score years, is not one our current health and social care systems were ever designed for.

Which explains the gathering of pace of Government-driven initiatives to change the way health and social care services are organised and delivered, changes that will have to cope with the vastly different cultures and organisations – including NHS, local authority, voluntary sector and private providers – that deliver these services to older adults.

For the scale of change that needs to happen – and the word ‘change’ doesn’t begin to do justice to what is required – there needs to be a revolution, and a very fast one, in the way services are run and data is gathered, managed, shared and used across the health and social care system.

Key elements of the changes are already underway.

The Care Act 2014 delivers the biggest changes to the legal framework, funding and provision of adult social care for over 50 years. It introduces care capping – implying the introduction of care accounts for the whole population – and a duty on local authorities to provide assessments, information and advice on care, and how to source it, for all-comers. This takes their responsibilities far beyond the much smaller group of individuals that qualify for local authority funded social care.

Alongside the Care Act is the Government’s integration agenda, supported by the Better Care Fund that transfers NHS budget to local authorities. No one knows quite how this is going to work, so 14 Integration Pioneers are busy working out new models of care based on joint working between primary, acute, community, social care and voluntary sector services.

Some of these Pioneers, including a cross sector team in Leeds, are developing ‘whole place’ approaches to managing demand across health and care, using the idea of a combined ‘Leeds £’, spent on care to guide their work, rather than the siloed budgets that tend to inhibit productivity gains through sharing.

Other pioneers are finding ways to give citizens much better access to information about their health and care, and much greater control over their support, with the aim of reducing dependency, preventing episodes of care, and prolonging years of independent living.

All these developments make common sense, but they are complicated by very significant IT and information management/governance implications. Major changes in approach and delivery are required in the back office, at the customer interface - which is increasingly likely to be a self-service website – and at the points where professionals need to share service user data and information to provide an effective, efficient service.

Cross-sector, digitally enabled health and social care requires new arrangements for safe sharing of patient/service user records between NHS, social care and other organisations involved in delivery. While this is easy to say, it is very difficult to achieve while overlapping information governance and assurance regimes are in place, with different parties insisting on their own arrangements taking precedence, and pragmatic solutions falling foul of real concerns about patient and citizen confidentiality.

Anxiety about information security and the conviction that older people ‘don’t do digital’ – increasingly untrue - have held back commitment to digital working in health, social care and voluntary sectors. This needs change as digital working becomes the only feasible way manage demand and also put the service user at the centre of delivery.

Much greater use and sharing of business intelligence, to aid understanding of customer journeys across the health and social care system, will be needed in future to enable prediction of demand and to plan and deploy resources to best effect across a city or other geographical location. Place-based approaches are going to be essential for services that will always have a large face-to-face element. 

Enabling patients and social care service users to self-service their information and advice needs will be really important, given local authorities new responsibilities to provide physical and financial assessment services, as well as ‘care accounts’ to track and manage delivery. Social care websites will need to meet the Government Digital Service aspiration to become ‘so good people prefer to use them’. Research shows they have some way to go.

The other side of ‘self-service’ is enabling patients/service users to access and manage their own health and social care records and, using apps, share this information with their own digitally enabled support network. Monitoring of vital indicators via devices that send the data back to health and care professionals will need to be deployed to cut face to face time spent with people living with long term conditions.

Vicky attended one of two health and social care summits organised by the Society of IT Management in collaboration with the Department of Health and the Association of Directors of Adult Social Care (ADASS). A series of regional events will follow this autumn. For more details, see https://www.socitm.net/policy/socitm-and-care-and-support-reform-programme

The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of The Information Daily, its parent company or any associated businesses.

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