VOICE OF THE INDUSTRY: Care chief calls for integrated health and social care

Integrated health and social care would transform support for people with learning disabilities, argues Dr Alison Rose-Quirie, CEO of Swanton Care and Community.

Friendships and relationships are at the heart of this year’s Learning Disability Week (June 20 – 26), seven days when we hope the world gives a little more attention to the lives of some of the most vulnerable members of our society.

No doubt the theme is meant to encourage debate about the importance of relationships for people in the LD community, and well it should, but as there will no doubt be many writing on this theme, I thought I’d look at this concept from a slightly different perspective.

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If we are to have real equality within society for those that organisations such as Swanton support there is one relationship that is in dire need of counselling: that giant, multi-faceted, complex, and at times downright baffling, relationship between the health and social care sectors in the UK.

This is a relationship that has huge implications for all of us, but perhaps none more so than people living with a learning disability, and other associated health issues.

Why? Because these are individuals who will often spend much of their lives in and out of many services operated by health and social care providers and the quality of the outcomes they and their families receive will be impacted by the amount of coordination between the two.

Historically the relationship between health and social care as sectors has been disjointed and disorganised and that’s why I am campaigning for a new relationship between our hospitals and our social care providers – surely the time for integration has come. Only then can we fully serve the needs of people with learning disabilities and ensure they get the seamless access to the services they deserve.

The Government’s Transforming Care programme should be the first step towards integration. It aims to improve services for people with learning disabilities and drive system-wide changes to enable more people to live in the community, with the right support, and close to home.

But this ambitious, and vital, agenda has already stalled with local authorities and clinical commissioning groups still arguing over funding and the government adding fuel to the fire by introducing a welcome but unfunded national living wage and creating uncertainty in the housing market by introducing “discretionary payment” into housing benefit.

I firmly believe that if we fully integrate our health and social care systems we could avoid these endless arguments over the funding of services for people in the LD community.

We could create one system that funded appropriate care according to assessed need where we could take advantage of economies of scale, identifying and removing duplication of roles and reducing the cost of the overhead of health and social care. Crucially the savings could be redirected to front line services, to the people with LD who need it the most.

So what would integration look like from the perspective of a person living with a learning disability?

If each individual had their own assigned case manager/care navigator they could support that person to navigate through a single system and ensure the right care and support is delivered at the right time.

They could also follow the person throughout their contact with the system and act as a broker/advocate to ensure they move through the system as their needs change and they don’t end up in inappropriate placements or failed as a result of placement breakdowns.

Crucially this would prevent people with LD getting stuck in acute treatment units (ATUs) and give them an advocate who knows which leavers to pull to get them the right support.

The ‘broker’ should not be an organisation that delivers the services but could be an independent organisation that is also able to provide analysis to identify who is at risk of admission to hospital and engage the right level of support in the community where possible to prevent admission. This won’t always be possible, but many could be prevented.

It must be our ultimate goal to have one single, unified health and social care service – the two are far too intrinsically linked to treat them as separate entities, with competing budget lines. I am convinced that you simply cannot create a system fit for the needs of the LD community in the 21st century if you do not make this happen.

Thankfully Manchester is leading the way. On April 1st Greater Manchester became the first local authority in England to take control of its £6bn health and social care budget.

Ten adjoining boroughs of Greater Manchester – currently responsible for social care such as older people’s and children’s homes and homeless services – started to collaborate with the 12 clinical commissioning groups and 15 NHS trusts and foundation trusts responsible for organising, buying and providing healthcare.

This coalition of 37 stakeholders is responsible for more than 100,000 workers caring for and treating the region’s 2.7 million inhabitants. A key goal is to reduce bed-blocking and to put people on appropriate care pathways.

Of course the jury is still out on this first bold step towards integration, and I will be keen to see how the LD community is affected by it; will they for instance have a case management system such as the one outlined above to help people navigate this new system? I would argue that it must.

So this Learning Disability Week let’s focus on the one collective relationship that arguably matters above all others – the relationship between the health and social care systems. A relationship that must get ever closer to ensure that we protect and support the most vulnerable members of our society.

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