The STAG is grateful to a supporter for this article which helpfully summarises where we are with the growing policy and local public service issue of health and social care. Taxpayers are not only concerned about their own ‘joined up’ care outlook but also the demands on our pockets as determined by the quality of its management. In particular the management of Inter-agency collaboration can make or break outcomes.
We are forever concerned about how we have to keep paying more and more rates and taxes for what seems to be just bureaucracy. So I was delighted to meet a team at one of Surrey’s Borough Councils recently that are dedicated to saving us money and being passionate about improving their services. They are the Borough Community Support Services team. We talked about looking after older people. Why would a STAG member want to talk about older people, you might well ask? It is not just because several of us are those older people with time to worry about these things!
It’s simple, really. The average age of the population is getting older by 2 months every year, consequently suffering poorer health for longer. NHS Surrey spends £1.6 Bn on our health, and the Council spends about 40% of its overall budget (less Education) on Adult Social Care (£374 M). A staggering 75% of this total is spent on looking after the 3% of the most critically ill people, who are commonly older people with long term conditions, such as heart or lung problems, diabetes and dementia. If there are ways of looking after these people more efficiently and effectively, then they surely must be taken.
It is a ‘must’ rather than an option. We will have 15 million senior citizens in England by 2020, with less working age people to look after us! If we don’t change anything, care will cost over 20% of GDP by 2050 (OECD report), so we have to change the way we provide care, or it will collapse. You can already see the strain it is under now, with press stories about health or care problems almost daily. It needs a new way of managing care that costs less, while also giving people a better service.
This can now be done by using modern computers and telecommunications to enable people to be cared for in the comfort of their own homes for much longer, instead of in expensive hospitals or care homes. And who would not prefer to stay at home? The facility is called telecare. This used to be simply about falls monitors, which raised alarms when you fell over, to call for someone to help you get up again. But now there are sophisticated home based monitors for all sorts of things like blood pressure, breathing capability, heart rate, and so on, so that an alert can be raised when conditions start to go in the wrong direction. Early corrective interventions will avoid serious episodes that mean emergency hospitalisation.
New telecare can save big money, because every A&E visit costs about £2,000 to process, followed often by a 7 day stay at another £4,000, then frequent outpatient and GP visits which keep adding to the cost paid for by the NHS. Moving to a care home will cost at least £35,000 per year, the average life there is 3 years, mostly paid for by the Council. But for people who own their own homes it can mean selling up and losing much of their children’s legacy. Keeping people in their own homes makes economic sense, as well as improving patients’ safety and wellbeing.
However, caring for patients in their own homes for much longer than presently possible, requires much more than just monitoring of their condition. The new telecare technology makes it possible to enable:
- Video consultations between carers and patients that gives carers a much better understanding of conditions than just looking at monitoring charts, or asking questions over the telephone
- Much more opportunity for the many care service organisations to collaborate on behalf of the patient. The commonest complaint about the NHS is that it is ‘not joined up’. But it is not just the NHS: Councils, Pharmacists, Opticians, Housing Trusts, Meals-on-wheels, and many others, all have duties of care, and need to be part of the ‘joined up care’ service
- On call contacts for the patient, with a variety of trusted specialists for advice, and video training and guidance reminders for self care, to enable them to understand and live better with their conditions, rather than suffering them. This alleviates the demands on (and costs of) professional staff.
- Provision of respite for personal carers (friends and family), whose dedication to caring for their loved ones makes a huge contribution that the authorities would otherwise have to take on, but creates great demands and stresses on individuals
Clearly, to make big savings in care costs, this technology needs to be deployed on a large scale. Then the question becomes ‘how can this be managed?’ The aim is to provide highly personalised care by a wide variety of care organisations to individuals living in a wide variety of circumstances with a wide variety of health conditions, and yet keep personal information very secure. This is both a technology challenge and a management challenge for the 21st century that most developed countries around the world are facing.
One challenge is that there are many suppliers of telecare equipment that are proprietary, which means that care providers have restricted choices for patients with complex needs, and may have to operate several systems to serve all their clients. This is not manageable on a large scale, and has been a severe limitation on the growth of telecare use.
Another major challenge to the authorities is the need for early identification of people who need help, because so much more can be done to prevent them going in to hospital and care homes. Both the NHS and Councils claim they only identify about 30% of people who could be helped, but they are different 30%’s, because there is very little collaboration between them! A typical problem is that an NHS hospital discharges a patient after a serious episode, who then goes home with no support, because the hospital does not refer the patient to Social Services.
What is interesting and very encouraging is that the Community Support Services team at the Council have recognised these challenges. They are working hard on collaborating closely with the local NHS, and are insisting that all telecare and telehealth is to be managed with a single platform, challenging suppliers to cooperate. What is more, they have impressed SCC with their efforts and plans so much, that they have been asked to take their programme across the whole of Surrey CC.
STAG members can look forward to joined up care in their final years!