Ever since the inception of the NHS, charities have played their part by providing additional support where it has been needed and where demand has outstripped resources. Charities, social enterprises and other innovative organisations appear to be continuing that work by providing step down units, community care or just a wider range of more appropriate settings dependent upon need. These organisations are significant to the health and care sector, underpinned by professional commissions, standards and delivery.
During this year’s General Election campaign, Future Care Capital proposed several key policy recommendations to raise awareness and encourage a debate between all political parties about the future focus of health and care provision. One of our proposals was to champion community-led health and care solutions – there are several very good reasons for this.
Our ageing population is due, in part, to the success of the NHS and care providers to support people in later life. Although it should be welcomed that people are living longer, if we do not adequately plan for the future challenges this brings, there are going to be consequences for the quality of life lived in our later years.
One issue impacting the quality of later life which would benefit from improved planning is what is termed ‘bed blocking’- that is, adult in-patients, predominately older people, occupying hospitals beds when they are no longer in need of acute care. Over 50% of the cases in question are as a result of a local authority failing to organise the next stage of that individual’s care in a timely manner, however, the NHS has a part to play in this too. There is an ongoing debate about whether the Health and Social Care Act is fit for purpose, if the targets set around delayed transfers of care (DTOCs) is realistic and attainable, and if there is a sparsity of coverage between local authorities. This then leads to a backlog of patients taking up beds across hospital departments, and impacts the ability of hospital staff to attend to the needs of the 1 million+ patients who seek help across England and Wales every 36 hours.
The National Audit Office (NAO) estimates that the annual figure for the number of lost bed days could be as high as 2.7 million – potentially costing the NHS £820 million per annum. The NAO has also said that patient information is still not routinely shared across the health sector, with various organisations having insufficient access to it at critical junctures in a patient’s care. This lack of communication also contributes to a build-up of dischargeable patients.
Tackling the challenges created by what are termed delayed transfers of care (i.e. ‘bed blocking’) is an increasingly important issue for the NHS, and it is easy to see how this has a knock-on effect across the whole health and care system. This costs the NHS money. New patients cannot be treated or face delays receiving care. Patients that have already been admitted can develop health issues because their discharge is not assessed to coincide with individual recovery needs. Added to this is a stretched workforce, not able to sustainably continue working in the way that they are, leading to a cliff-edge in support further down the line.
The causes of this are complex. Although it is argued by some commentators as being attributed to austerity measures – in particular, the savings made to local government budgets and reduction in adult social care provision – figures from November 2016 indicated that councils from across the country that have reduced spending on social care have not seen a difference in their number of DTOCs compared to those that have maintained or even increased spending.
It is reasonable to argue that community-led health and care solutions could be the answer to the problem.
Participatory City is a new type of project that looks set to build a large urban demonstration neighbourhood in the London Borough of Barking and Dagenham. Working with the local authority, individuals and other organisations, the intention is that over a 5 year period this neighbourhood will become a model of equality, wellbeing and sustainability. The main aims of the initiative are to re-organise the current systems of participation, to allow new platforms, networks and spaces to be built, that ultimately create conditions where citizens, government and other institutions can collaborate together more effectively to invigorate places. This new approach sees participation as a key building block for building cohesive and sustainable cities of the future.
Casserole Club a new kind of community project set up in 2011, was especially designed to connect people who like to cook, with their older neighbours who aren’t always able to cook for themselves. The creator knew that there could be a positive and very human way to help tackle some of the health and social care challenges society faces today. The club works because it takes something volunteers are already doing and transforms it into a service that helps make local communities stronger.
North London Cares is a community network of young professionals and older neighbours socialising and helping one another in the capital. The organisation seeks to address the disconnection in London by harnessing the people and places around us for the benefit of all by: reducing isolation and loneliness amongst both the older and younger communities; improve the connection, confidence, skills, resilience and power of all participants so neighbours can feel part of the changing city, and; by bringing people together to reduce the gaps across social, generational, digital, cultural and attitudinal divides.
Men in Sheds is a movement that can attract anybody of any age and any circumstance, but typically sees mainly men that are widowed or live alone, or that have retired. It is this lack of a working role that can bring a loss of identity, status, friends, income and even a sense of purpose. Social isolation can often occur if friends, family or a support network aren’t in place, and this movement intends to help alleviate that. Research has shown that there are health and well-being benefits to men when they participate in this sort of activity, if only for a few hours a week.
Public health, preventative health, behavioural health – must all be taken into consideration. Helping to shape individual’s behaviour to manage their own health can keep individuals out of an acute or care setting for longer or all together, avoiding unnecessary admissions when there may not be a clinical need to do so.
Future Care Capital believes there is a pressing need to nurture community-led health and care initiatives. We would therefore welcome the creation of a new civil society fund to stimulate and grow pioneering and sustainable community-led solutions through locally controlled ‘community health and care budgets’. This fund would complement existing local health and care budgets, and be incentivised and targeted in a manner such that any initiative were cost neutral.
There is no single, simple solution to these interwoven issues, and to fixate on just one would be missing the point. Joint working, a more unified approach to health and care, and a change from “the norm” might just be the best course of action to deliver a community response to the challenges faced by our aging population.