With an increasingly elderly,
frail and co-morbid population, the need to coordinate health and social care
is becoming more and more apparent. One could argue that integrating health and
social care is the big issue facing the NHS and our care services.
The Atlas of Variation in social care published earlier this year, examined the quality of social care services in England.
Like our Atlas of Kidney Care and the other health care atlases, it showed high variation in access, uptake,
costs and quality – a postcode lottery. The social care atlas mapped its data
to the Adult Social Care Outcomes Framework:
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Enhancing the
quality of life of people with care and support needs;
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Delaying and reducing the need for care and support;
-
Ensuring people have a positive experience of care and
support;
-
Safeguarding adults whose circumstances make them
vulnerable and protecting from avoidable harms.
A large read
across to the NHS Outcomes Framework don’t you think? Any reasonably minded person can see the link between the
various outcome frameworks from Public Health, NHS Outcomes, by which the Secretary
of State for Health will hold the NHS Commissioning Board to account, the Commissioning
Outcomes Framework to help deliver on those health aspirations and the Social Care
Outcomes Framework. If they were all playing in concert, it would sound more
like Schönberg
than Mozart would. The staff in the various sectors are not working
together yet, and we do not routinely join up information. Good health care
leads to recovery and return to normal living. Poor health outcomes have their
consequences in the lives of families of those affected, in the metrics of the
Department of Work and Pensions, along with the social care needs of the
individuals.
When it comes
to the last years of life, social care needs are clearly as relevant as health
care intervention. In conservative kidney care it really is not about the
kidney, it is about the individual their experience, their family, carers and
friends.
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| An atlas of variations in social care: an analysis of the quality of social care services in England, June 2012. MNP Health Mandate |
What role should social care play
to support someone at the end of life to die in his or her own home? In
addition, how can health and social care services work together to make this
choice a reality?
A thoughtful and groundbreaking
study published by the Nuffield Trust adds significant weight to the argument that with the right support people
could die at home, as they wish.
The report vastly improves our
understanding of the costs of caring for people at the end of life and
encourages a debate on what role integrated, coordinated care can play in
keeping people at home in their last days.
“Our ageing population and over
stretched health service means that the NHS will not be able to meet the rising
costs of people being admitted to hospital unnecessarily at the end of life.” Ciaran Devine CEO at Macmillan Cancer
Support and Non-executive member of the NHS Commissioning Board
You will not be surprised to
learn that understanding patterns of
health and social care at the end of life also, reveals the large
variations in access, uptake and costs.
 |
| Understanding Patterns of Health and Social Care at the end of life, October 2012. Nuffield Trust |
The Nuffield Trust work shows
that the cost of caring for someone in hospital increases sharply in the final
few months of life- especially for emergency care. The costs can be as much as
£90,000 per person. Social care costs, however, are more predictable and
constant and home care is on average considerably cheaper than hospital care.
Note the different scales on the vertical axis comparing the hospital and
social care costs in figure 4.4 from the report above.
Care for people at the end of
life needs to improve as a matter of urgency. This Nuffield report chimes with what I have heard from
kidney, primary care and social care professionals, about how it is often help
with small things, can make a big difference fro patients and families, and is
crucial to keeping people out of hospital at the very end of life. We should
seize the opportunity of the current flux, we find ourselves in health, the
financial challenges our Local Authority, and Health and Wellbeing boards are under
to make step change improvements in end
of life care and deliver on the NICE QualityStandards.
