Breaking down the boundaries in health and social care

For increasing numbers of people, health and wellbeing is no longer a sub-conscious state requiring episodic contact with health services to fix something that is broken. Instead, it is a matter of active and ongoing – often lifelong – intervention and management, requiring varying degrees of support from families, communities, and health and care services. This is true at all ages – from families with a child with a disability to adults managing long-term conditions, and most frequently, frail older people.

As health professionals, this challenges us to think about the way we work; to test the assumptions on which we base our practice, and to have the courage to change local services to meet people’s needs and preferences. And people are clear about the things that matter to them: they want to get on with living their lives, remaining 'as well as possible for as long as possible'. They want to be able to tell their story just once, be treated as a person, become a real part of their care team, receive safe care closer to or at home, and receive consistent communication from caregivers. They want to have improved choices, access and services that fit into their lives: services that both support independence and provide compassionate care when it is needed, right through to the end of life.

We know that effective community services are vital to providing sustainable, 21st century care, and health and social care professionals and clinical leaders are key to delivering the necessary service changes. However, patient representative groups are clear that we need a new mindset to make this happen. They suggest that we need to move from a 'my patients' view, to look at our services through the lens of patients as ‘clients, customers and citizens’: clients who know what they want to achieve, are experts in their health condition, and who seek expert support and advice as partners; customers who want accessibility, choice and joined-up, convenient services; and citizens who have the right to high-quality health and social care.

As professionals, to make a difference we need to improve integration and embrace innovation. A recent report by Queen's Nursing Institute found barriers to integration, such as slow information flows and multiple care records. If we apply this new mindset to these issues, then individuals would ‘own’ their health and care information and we must then question the value of multiple care records and disjointed information systems. We are also challenged to balance the number of practitioners involved with the individual’s desire for fewer people with stronger relationships. We need to know whether this is truly a matter of expertise or just who provided what historically, and we need to think about new roles that support independence. We are investing in new clinical leaders and we need to equip them with the courage to challenge the status quo and the skills to lead.

Technology is a fundamental part of modern living and will be central to innovation in health and care. Again looking at it with our new mindset, technology in health and social care should become what people want it to be and not what professionals think it should be. Clinical leadership and integrated organisational developments – informed by real patient/public participation – can enable us to provide safe care at home and support for people with long-term conditions enhanced by telecare and telehealth. 'Activated patients' will be supported with improved information – including access to records – and digital services, such as appointments and prescriptions. Health apps and social media expert patient groups are growing and can develop into fully engaged communities.

Integration and innovation challenge professionals to think differently and to practise in new ways: bringing together the enduring values underpinning care, forging new relationships with patients as partners and across agencies, and embracing new opportunities and technologies to improve people’s health and wellbeing.

Visit Viv Bennett’s website for more blogs from Viv and her colleagues at the Department of Health

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