Unmet need for health and social care: a growing problem?

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There is a great deal of focus in the health and care system on measuring the quality of care being provided. But what about care that isn’t provided at all?

We have published several reports this year highlighting pressures in community-based services, including social care and district nursing. These pieces of research raised concerns about changes to the availability and quality of services as a result of rising demand and insufficient funding and staff numbers. The reports also raised concerns that these pressures might be leading to rising levels of unmet need.

Unmet need is difficult to define, and harder still to measure. This would be true in any setting, but particularly for services like district nursing that are delivered in people's own homes. People who are not receiving district nursing care but would benefit from it, or those who are receiving some care but require more than they are currently getting, are often out of sight. There are no overcrowded waiting rooms or queues to bring this unmet need to light.

Local authorities are required to seek to identify unmet need for social care. But currently, monitoring arrangements are only in place in just over a third. Recent research from Age UK estimates that 1.2 million older people are not receiving the social care they need, a number they report has increased by almost half since 2010. This means that more people who have difficulties with activities of daily living – such as washing, eating or going to the toilet – do not have the support they need.

These findings are hardly surprising when you consider the context: our research found that the number of older people receiving publicly funded social care fell by a quarter (more than 400,000 people) over the past five years, despite growing numbers of older people living with high and complex care needs.

This not only affects the individuals struggling to cope without the support they need; it also puts additional strain on their carers and family members. Knock-on consequences for the health service are also inevitable. Many of those struggling to cope may eventually reach the door of A&E, and subsequently find themselves among the growing number of patients delayed in hospital while they await the care they need to be safely discharged.

And what about unmet need for NHS services? While the social care system rations services to those with the highest needs and is heavily means tested, the health system prides itself on being ‘free at the point of use’ and meets a wide range of needs. But we are hearing growing concerns through our research that unmet need for health services may also be growing. However, as in the case of social care, this is innately difficult to define, detect and measure. In addition, unmet need may not only result from straightforward denial of access. NHS services may be rationed through a number of mechanisms, including longer waiting times, higher referral thresholds, difficult access acting as a deterrent, deflection of care to other providers or payers, or dilution of the level or quality of care provided.

Early next year we will be publishing a report examining the impact of NHS financial pressures on patient care. This research looks in detail at whether the availability and quality of patient care has changed as a result of resource pressures in four service areas. During our research we, once again, heard concerns from interviewees that unmet need is growing, particularly for district nursing care and sexual health outreach services, which have been affected by significant cuts to public health budgets.

When considering the performance of the health and care system – particularly during this period of huge financial and operational pressure – it is important to focus not only on what the service is doing and how it is doing it, but also on the things it is not doing and what that means.

Comments

Nick Welch

Position
International Ambassador,
Organisation
Bone and Joint Decade
Comment date
27 November 2016
I have been championing patients at various Committees for over a decade. Co-operation between Health and Social care has been an issue all this time. There seems to have been a determine
d effort on both sides to block any initiatives to create a joined up serice. My local Community Health Trust (DHCFT) and Community Health Services Trust (DCHS) are planning to join forces - a long awaited initiative.
However as the criteria for accessing social care services differ between different Trusts I am still at a loss to understand how some patients will benefit - when they are sent to a Hospital in a different Trust.
I wonder if the new initiative published by the RCGPs & the BGS (24.11.16) will fly? It would have been so much much more encouraging if social care had been the third author!!
I hope those responsible for caring for us, butn particularly the elderly and frail get your act togather before I need you!!

Andy HARRISON

Position
Director,
Organisation
Path-to-Health Limited
Comment date
28 November 2016
One reason we keep on revisiting the same 'challenges' might be because continue to work on the somewhat idealistic basis that the health and social care system is a 'system' not, instead, hundreds of competing organisations and business interests that do not necessarily share the same objectives, operational cultures etc. In the over 20 years I worked in the NHS and 15 yrs with LAs and charities delivering PPI projects I found this to be invariably the case- especially when it came down to the bottom line-money (though should really be the patient).

Realise 'vanguards' are set up to try and define and solve some of these organisational change problems and while there is some limited success, integration problems remain significant - running across LA organisations, private companies, NHS providers and commissioners (including NHS England) and we are fast running out of time. It might be time to consider how a National Care Agency might contribute to 'breaking the mould' both culturally and in terms of the way things get done

Christine

Position
Director,
Organisation
Act on dementia cic
Comment date
28 November 2016
Andy i agree with a lot of what youve said. And locally sat on our integrated board for HSC for 3 years we had vanguard status.
I do think care agencies could help a lot with homecare, AS has a campaign runing called homecare is broken fix dementia care, thats its taken to the gov. Untill we invest in specific dementia training for dom care agency staff and we have a minimum standard nationally and we commission differently and work with dom xare agencies more...nothing will change.

George Coxon

Position
Various inc care home owner & advocate,
Organisation
Multiple
Comment date
28 November 2016
We are speaking up speaking proud being keen and remaining willing to join with our commissioning colleagues with the determined view that we're in it together. This against a body of growing evidence that any of our positive offerings are unable to make any difference to an imminent catastrophic destruction of choice, care and support for our older people.
I'm presenting at our local AHSN event on Wednesday (Sharing Best Practice) then at our Local Authority provider engagement conference on Thursday then am part of nxt weeks Kings Fund 'enhancing health in care homes' event then we have our 3rd Devon care home kite mark annual Jamboree all events I will be saying position be things. Being arguably naive but determined not to be a whinger ( I've taken to say "no one likes a whinger' - lot of late). I attended a CCG consultation last week and spoke up about STP status for us all, Better Care Fund ambition unrealised and the frustration about Vanguard new care models that whilst celebrated feel distant and very NHS heavy.
This blog whilst very relevant and well constructed is another arms length voice commenting at a safe distance dare I say about the plight of front line services More important than any of the events I'm invited to speak at are the 2 residents and guests meetings we are having at my 2 care homes tomorrow. We have some work to do in reassuring families that we are 'good' as deemed by CQC in the wake of the latest Panorama expose last week. We are actually better than good but like all those addressing unmet need in H&SC we are very anxious about a lack of acknowledgement of the cliffedge we are teetering on. Tomorrow I'm also hosting a group of newly installed Councillors visiting one of my care homes. They will chat with Meg - our energetic multitalented carer, say hello to George with his new hat, meet Lucy, Marion and others. I'm hoping I can impress upon them how vital them seeing and believimg that our work needs more local investment - perhaps daring to introduce a ringfenced 'social care levy' in raising council tax but greater still apply more understanding and less condemnation to those of us really dong all we can to protect services, look after staff and especially older folk in our care Check Pottles blog for further insights on how we try to combat doom and gloom our last posting was titled 'responding to poor care'

Thanks for the prompt to say a few things on our behalf and on behalf of those needing good care



with the massively well documented H&SC pressures

Hannah Clifton

Position
Director,
Organisation
ME Trust
Comment date
30 November 2016
Thank you for raising this issue. Unmet needs in both social and medical care is a major issue for the 250,000 people in this country with ME/CFS. Many fall through the existing care net. The severely affected - bed and housebound - are often left with urgent unmet needs. Change needs to encompass those who's voices have yet to be heard.

Hannah Clifton

Position
Director,
Organisation
ME Trust
Comment date
30 November 2016
Thank you for raising this issue. Unmet needs in both social and medical care is a major issue for the 250,000 people in this country with ME/CFS. Many fall through the existing care net. The severely affected - bed and housebound - are often left with urgent unmet needs. Change needs to encompass those who's voices have yet to be heard.

Pearl baker

Position
Independent Mental Health Advocate and Adviser/Carer,
Organisation
Independent
Comment date
01 December 2016
The latest development in West Berkshire is changing a diagnosis from Schizophrenia to 'Personality Disorder' your section 117 Status is no longer valid? we are no longer responsible for you. 'Unmet needs' are the tip of the 'iceberg' for this woman, often beat up, money taken away from her.

It is unbelievable that a LA would stoop so low in order not to Care or Support this vulnerable woman.

To be diagnosed with a 'Personality Disorder' there is a rigid assessment process? this has never taken place.

I have suggested to the mother and her daughter a request to view her Medical Records from the Hospital and the Community, also to contact a Solicitor specializing in Mental Health LAW. The daughter would be entitled to Legal Aid.

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