In the 1970s, when I was a young social worker in A&E, most of the emergencies referred to us were mental health, hopeless drunks, homeless people and child protection. Older people were rare referrals but in those days there were many geriatric hospitals and residential care homes. Today’s system leaders are increasingly viewing A&E as controlling demand, capacity and flow throughout the whole NHS system and mainly focusing on older people. This is fundamental to the acute and primary care health economy but even more importantly it is also crucial for social care and therefore for the whole health and social care system.
Nuffield Trust and Kings Fund research noted the DToC figures were the highest on record last winter for delays attributable to both social care and health. A quarter more than the previous year. The number of delayed days for social care alone were 36% higher than the previous year. Just over 30% of delays are attributable to social care with the main reason being patients awaiting care package in their own home. This proportion is also steadily rising. It seems inevitable that those older people who present as emergencies will be the most likely to become delayed transfers of care but the evidence is not there yet. As the NHS start to separate bed day figures into emergency and non emergency that will become a lot clearer.
As Professor Paul Burstow, former health care minister wrote in the Guardian recently,
" Social care, and the NHS for that matter, needs to be more data driven. Only by taking a population health approach and making better use of technology can we begin to move towards more predictive, anticipatory care models that reduce the demand for costly crisis care."
Meanwhile, the national imperatives for the NHS in A&E are
- Retaining the 4 hour A&E target (ignore other rumours)
- Hitting 95% of the target all of the time
- Development of a new metrix for emergency admissions
- New definition of length of stay to include “emergency” bed days
- Development of new A&E Score Card
- Using the £2bn for social care funding to speed up discharges
- Whole system leadership for demand, capacity and flow
Let’s focus on Directors of Social Services and their NHS colleagues. What you they need to know on a monthly, weekly and daily basis ? What Dash Boards do they need so that they can make the right decisions? So they can give their teams immediate insights that are actionable and evidenced based.
- Excellent research like the Kings Fund and Nuffield Trust which captures a moment in time needs to be supplemented by continuous data feeds.
- Data must demonstrate the whole picture across social care and health
- Data must be presented in Dash Boards which are visually accessible, designed for decision makers to facilitate better decision making
Ambitious but necessary to monitor the financial and activity impact of all these inter-related factors.