Not sick enough for hospital, not well enough to cope

Another day, another report concluding that “integration” is what will save a health and social care system that is rapidly descending into further crisis.

As politicians continue to argue over the rights and wrongs of Andrew Lansley’s Health Bill, the one thing everyone does seem to agree on is this catchall buzz-word. We’ve had the think tanks the King’s Fund and Nuffield Trust, the Audit Commission, and today the Health Select Committee, conclude that bringing the worlds of health and social care – which currently have separate funding models and separate priorities – closer together is vital for patients, and will deliver substantial benefits for taxpayers.

But despite this consensus, so far little has actually changed on the ground, and too many people are continuing to fall down the gap between health care and social care.

Patients are still stuck on hospital wards when they are medically well enough to leave but have nowhere to go – with more than 69,000 bed days lost to ‘bed blocking’ in December alone. Vulnerable people and the elderly are still seeing their health deteriorate and their confidence vanish because they are not getting the simple support that would help them live independently with dignity in their own homes.

This is unacceptable and unsustainable – hampering patients’ recovery and wellbeing while also costing taxpayers millions of pounds in unnecessary hospital bed days – as the authors of the many reports well know. But on the bright side it can be tackled when the worlds of health and social care work together, not against each other.

Take for example the primary school teacher and mother-to-two that British Red Cross volunteers recently supported in West Sussex after her battle with cancer. After gruelling chemotherapy treatment she returned home and found it was the simple things that she was struggling with; emptying the dishwasher, sweeping the floor, and bringing a sense of normality back to the home. Thankfully they sent a volunteer – trained to provide emotional and practical help, from a listening ear to picking up prescriptions or linking with GPs – to offer support, support which made the difference between coping and not.

These kind of services fill the gap that the reports warn of – supporting someone who is not sick enough to need medical care and does not have substantial enough needs to qualify for a social care package. Yet these services are all too thin on the ground, and as budgets bite the British Red Cross has seen our home from hospital services cut by local authorities in a desperate and short-sighted scramble to save money. The problem is exacerbated because health and social care budgets are separate, leading to inconsistency about just who should pay for these ‘in between’ services.

To achieve integration and a world where patients’ journey to health moves seamlessly, much work needs to be done. The tariff system of payments must be addressed; the inconsistency of eligibility criteria must be acknowledged. But surely the best place to start is simply to start offering more services which bridge the gap.

At a time when social care budgets are shrinking, while the need for services is growing, we understand it is hard for commissioners to find cash to invest in preventative services like these home for hospital schemes. But that is a false economy. Only by investing in services that embody “integration” will the vision that all these reports offer finally become a reality.

Michael Adamson, acting Chief Executive, British Red Cross

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