The new winter wonderland is fraught with complexity and uncertainty. This means leaders are skating on very thin ice indeed. Whilst it’s encouraging to see a growing appreciation of the intricacies and pressures of health and social care economies, the need to look at the resilience of the whole system is never more important.
The debate on older people stuck in hospital will inevitably become increasingly toxic. The Better Care Fund appears to be in jeopardy due to unrealistic expectations about the impact of system changes being driven nationally. Many would say that the additional £2bn to social care was too little too late and so it’s perhaps not surprising that it has not had the impact on the NHS that was envisaged. The increasing frailty of the home care market is now adding to the problems and may well be more significant than the pressures on the Care Home market. And here comes the winter flu H3N2 strain from Australia, which had its worst outbreak on record this year. Older people are particularly vulnerable: flu vaccines tend to fail in 50 to 80 per cent of older adults, and more than 90 per cent of flu deaths occur in this age group.
Today’s NHS system leaders are increasingly viewing A&E as controlling demand, capacity and flow throughout the NHS, but not necessarily in social care. The new national imperatives for A&E include meeting the 4 hour A&E target hitting 95% of the target, developing new metrics for emergency admissions, the A&E Score Card and a new definition of length of stay to include “emergency” bed days. This latter will bring a more sophisticated understanding of the patient flow.
NHS Improvement says the level of delayed discharges is increasing, despite the extra £2bn for social care services. Actually the rate of increase at barely 1 per cent is not significant, but it is moving in the wrong direction and this masks considerable variation across the country. The DToC figures were the highest on record last winter, the numbers for social care alone being 36% higher than the previous year. Just over 30% of delays are attributable to social care with the main reason being patients awaiting care packages in their own home.
We all know the demographics story. So when Sir Michael Marmot commented that life expectancy rises grinding to a halt is more significant than the winter crisis, there was a collective drawing in of breath. Some of us will recall Professor Ray Tallis challenging Directors of Social Services a few years back with the concept that living longer doesn’t necessarily mean living unhealthily. It all depends on the data.
Professor Paul Burstow, former health care minister says,
” 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.”
So what do Directors of Social Services and their NHS colleagues need to know? On a hourly, daily, weekly, monthly basis ? What dashboards will help them make the right decisions with insights that are actionable and evidenced based ? I’d suggest:
- Data must demonstrate the whole picture across social care and health with integrated data showing one version of the truth
- Research which captures a moment in time needs to be supplemented by continuous data feeds.
- Dashboards must be visually accessible, designed for senior decision makers, as well as analysts
Julia Ross is former Director of Social Services and CE of Barking and Dagenham PCT. She is now Chief Strategist: Care and Health at PredictX ( formerly Pi Ltd)