Breaking down the boundaries in health and social care

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Part of Time to Think Differently

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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Comments

Anita Rolfe

Position
Deputy Director Patient Experience,
Organisation
NCB Greater Manchester Area Team
Comment date
28 February 2013
I agree that Integration of all care provision, and working beyond organisational boundary will need to be the solution to ensure that the experience of patients improves and is reflective of the 21st century. This will require staff to work in different ways and use technology that supports patient care.
Workforce planning and workforce development needs to begin as soon as possible in order to ensure that the right skills are in the right place at the right time for community health and social care as well as in primary care.

Patrick Morreau

Position
Patrient Rep,
Organisation
Haringey CCG
Comment date
01 March 2013
I strongly agree with all Viv Bennett says - ntegration and innovation are essential. But her emphasis is all on medical care. For a truly integrated, person-centered approach we must achieve integrated health and social care, and embrace the innovation and technology to enable this.

Ken Holton

Position
GP lead,
Organisation
Coventry & Warwickshire Partnership Trust
Comment date
01 March 2013
Spot on!
Starting from a position of paternalistic care planning we have contrived to exclude ordinary people even more on the basis of needing to control process for such reasons and health and safety, adult protection, CQC monitoring and the like. The incessant media drive to improve accountability and probity serves to exclude the public from their own care and the care of the community simply because we cannot control them.
To a lesser extent we make contracts very difficult for charitable and small caring organisations and treat them as inferior or second class.
Well, Viv, you say we need to improve integration. Absolutely. How?

LYNNE HEAL

Position
disabled,
Comment date
01 March 2013
UK needs to move forward faster with MS and help move directions to the vascular way with CCSVI unblocking their veins and valves in their necks , we are so behind its embarrassing and unethical too

Michael Crawford

Position
Consultant Medical Oncologist,
Comment date
04 March 2013
Historically, the format of the NHS in the late 1980s was all about District Health Authorities which ran the hospitals and contacted GPs and everything else were constituted as closely as possible to share boundaries with local authorities that ran social services. The explicit purpose of this was to foster integration. In those far-off days we used to have a social worker attending our multidisciplinary ward round meeting every week. The problem was that it was severely underfunded.

Then the government of the day took another step on the quest to design a small, cheap NHS that will achieve as much as a full-sized health service. In order to contrive a market the service was deliberately dis-integrated.

The use of technology is essential to integrate services; communication is indeed everything in this respect. It creates its own dilemmas; in the hospital that employs me and sometimes treats me (Viv, would you mind awfully if I called it “my hospital”) we are developing precisely this kind of use of technology but data protection being what it is we have to ask patients if they mind data being shared. We don’t have to do this if we are just writing letters.

A crucial thing about technological solutions is the need for data entry. The system that we use to communicate about cancer patients is fantastically useful provided the record at the Cancer Centre is up to date. In fact technology is not an end in itself, it is a tool which achieves great things in expert hands. There are such experts in communications in clinical matters. One of their skills is typing, essential for the entry of data and of clinical ideas and opinions. They also know to whom they should speak and when to make arrangements for patients. Those who are appointed for their clinical skills achieve much more by being able to delegate this work to a communications expert. However, many Trusts are reducing the availability of communications experts, thereby reducing efficiency much more than they reduce costs. You may know these essential healthcare professional as medical secretaries.

Jamie Buttrick

Comment date
04 March 2013
What are the options for non-IT/internet based technology solutions for personalisation for example? Technology is fine and needed more and more but the most vulnerable in society will require additional support in order to benefit from the integration of health and social care and choices/information to maximise the benefits of personalisation.

Chris Gordon

Position
Lecturer Health Visiting,
Organisation
University Campus Suffolk, Ipswich
Comment date
05 March 2013
I agree that technology is fundamental to the integration of care and sharing of information but who we are as professionals and how we work together is just as important. Interprofessional learning and working is required if we are going to achieve effective collaboration between professions. We need to break down barriers such as professional divisions, hierarchies and different value systems.

Terence Singleton

Position
innovator,
Organisation
Singleton Products & Services
Comment date
30 April 2013
Viv I am so pleased to have found this site, you can not believe the frustration of trying to break through the Professional luddite attitude of therapists, We have a system to relieve sciatic pain in 45 min and is a Nursing tool, but can we get past Physio's! no because they are given in total 24 weeks to try to achieve the same, when a nurse in primary care could do it in an hour. 'Help' if you can, regards Terry

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