28 October 2015

Elderly care: the importance of an integrated approach

Older people often have complex, chronic conditions and there has been a significant shift in recent years by health and social care providers towards greater integration in the provision of elderly care services (including residential care) to meet these needs.

The number of people aged 65+ in the UK is projected to rise by nearly 50% over the next 20 years to more than 16 million, and the number of people over 85 will double.
For many, these extra years will be a blessing thanks to good health, sufficient retirement income, and a fulfilling social life. Unfortunately for others, longer life can usher in a decline in quality of life, chronic health conditions and an increasing reliance on the care system. Around 72% of recipients of social care and around 45% of health and community services expenditure is on people aged over 65. The rising demand for health and social care services presents major challenges for the NHS, social services, and other care providers, as well as older people and their families.

Why is integrated care needed?

People with complex care needs may require specialist input from a range of different health services and care providers, so there is always the danger of some people ‘falling through the gaps’ due to the fragmentation of services.
Not only are services fragmented but they can also be difficult to access, and crucially, may not be based necessarily around the patient’s or carer’s needs. Services need to be properly co-ordinated.

What is integrated care?

National Voices, a leading coalition of health and social care charities in England, defines integrated care as ‘person-centred, co-ordinated care’.
An integrated care approach focuses on a single point of contact, effectively a care manager, who will:
• help with assessing needs
• share information with care providers and families, and
• co-ordinate the delivery of care from multiple caregivers and providers.

The benefits of integrated care

UK government guidance says that good integrated care can reduce:
• confusion
• repetition
• delay
• gaps, duplication and other inefficiencies in service delivery
• people getting lost in the system
• costs.

What should good integrated care look like?

If you have an older parent or relative who needs care and support, it can often be difficult to understand exactly what to expect from integrated care. Generally, integrated care should achieve:
• better planning
• more personal involvement of the person using services, and
• free access to good information.

The Care Act 2014

Changes to the Care Act in Spring 2015 require local authorities to work more closely with health services to improve the integration of care and importantly to improve how people experience health and social care.

This might mean that if your older parent is admitted to hospital, NHS staff must work with the local council to ensure the patient gets personalised support when they are discharged. Social care departments in local authorities also need to collaborate with other services such as housing to ensure patients can live an independent and hopefully a fulfilling life.

How is integrated care being regulated?

In England, the health sector regulator, Monitor, has a duty to facilitate better integration of health and social care services. Monitor is sponsored by the Department of Health and works closely with the independent regulator of health and social care, the Care Quality Commission (CQC). In addition, the statutory watchdog Healthwatch, works at a local level to ensure that the government and the various health and social care services, ‘put people at the heart of their care’. Questions and feedback about health or social care services can be directed to your local Healthwatch.

Making integrated care work better

One of the key challenges to ensure the delivery of effective multi-agency integrated care is to create a culture of co-operation and co-ordination across health, social care, public health, other local services, as well as the voluntary sector. The good news is that the UK government and a wide range of organisations are committed to examining ways of improving care for the elderly. If you wish to explore the work that the major organisations are doing, you might be interested to explore some of the following:
Government collaboration The government is working in national collaboration with a range of charities, public bodies and professional organisations to ensure high quality integrated care and a better experience for patients, carers, and families. A full listing of organisations in this national collaboration can be found in the government document Integrated Care and Support: Our Shared Commitment.

Government action plan

In 2014, the government published a five-year action plan called Five Year Forward. Key points of the plan include giving people greater control of their own care, including having shared budgets combining health and social care, and to facilitate more integrated, multi-agency care delivered locally.

Think Local Act Personal (TLAP) is a partnership of around 30 UK organisations working to effect real change, especially the ‘personalisation’ of adult social care services. TLAP’s online planning tool uses a range of case studies (see above) to help agencies understand better how to deliver person-centred, co-ordinated care.
The Centre for Ageing Better was set up in 2015 with £50 million from the Big Lottery Fund, the Centre for Ageing Better is an independent charitable foundation that aims to help people have a better later life. The centre commissions studies, funds projects, and shares information to help to bring about evidence-based change.
The King’s Fund TKF) is an independent charity working to improve health and health care in England by shaping policy and practice. Encouraging the widespread adoption of integrated care is a key priority for the charity.