‘If you were Health Secretary how would you save money?’ This is a common question at medical school interviews. How would you answer it? Social care has been in the news a lot this week because of reforms being discussed in Parliament. The subject of integrated health and social care might provide an answer.
Social care sounds boring and hardly relevant to medicine. But it is. Why? The elderly make up the majority of the hospital population. Yet as stated by David Nicholson, Chief Executive of the NHS Commissioning Board ‘Hospitals are very bad places for old,frail, people’.Hospitals are are organised around the care of younger, fit adults presenting with a single problem. The elderly often have multiple illnesses [multi-morbidity] and the specialisation of hospital medicine often does not suit them. All patients need to be treated holistically – that is paying regard to all their physical problems, their psychological and mental health [depression and dementia are common] and their social needs. Hospitals are not set up to do this well.
Many believe that after an acute illness is treated the elderly should be discharged as soon as possible. However a care home can cost £50,000 a year, more than sending a child to Eton or a cabin on the QEII! It is therefore no surprise that Social services [funded by the local authority] and relatives sometimes want them to stay as long as possible in hospital. Sometimes, such patients are known as ‘bed blockers’ a derogatory term used to describe people who no longer need any medical input but would not be able to cope alone at home.
There is a division between health services and social services and their funding. There have been moves to join budgets to provide what is called integrated care and join together health and social care budgets. Integrated care teams have been created, as have ‘virtual wards’. Patient can be discharged to a virtual ward working with an integrated care team until they are completely fit. Translated this means that elderly patients, who are still weak, can go home with carers coming in three or more times a day – to help them get up and dressed have breakfast, check that they are ok and have lunch later in the day and then help them get to bed at night. Carers help give them their medication; community nurses will also visit. The patient’s medical needs are provided by district nurses and doctors who visit regularly to manage their care. It is expensive – probably no cheaper than a stay at a care home but patients usually prefer to be in their own home and it is a fraction of the cost of hospital care.
So one answer you could give to that common ‘If you were health secretary…?’ question could relate to increased use of integrated care teams and virtual wards.