Integration of health and social care

Examining the integration of Health and Social Care within our region

In February 2017 a cross-functional working group within Brunelcare was established to compile and publish a report evidencing how Brunelcare contributes to the integration of Health and Social Care within the region in which the charity’s services are provided.

A key focus for the working group was to respond to the National Audit Office report published 8th February 2017, entitled ‘Health and social care integration’; also exploring how the work of Brunelcare supports and evidences the integration of health and social care.

In gathering evidence, the group focused on two specific elements of Brunelcare’s performance:

1. Reducing hospital admissions
2. Reducing the delay to transfer of care from hospital to other settings

Report’s key findings

• Brunelcare is recognised as being at the forefront of new, innovative initiatives and the work detailed in this report highlights those that have been particularly successful.
• There are many best practice initiatives described in this report that have led to improved outcomes for the people accessing services from Brunelcare. Examples from the Falls Project, End of Life Care work, Pathway 2 and Reablement and the Health & Wellbeing Officer pilot all provide a picture of best practice that is to be commended.
• With Brunelcare’s falls management expertise, we can evidence an innovative and outcome-focused falls management system within our own care homes. Our Council funded Falls Management project, led by Brunelcare, was also successful in improving the management of falls in many homes in Bristol; with evidence generated from this project enabling further funding to be secured from NHS England for further work on Falls Management in Care Homes.
• The Falls Management Project also highlighted to us that sharing work and best practice initiatives with other providers and colleagues from health and social care has been a valuable way to stimulate integrated working.
• Working in line with the Gold Standard Framework (GSF) Guidelines for End of Life Care encourages us to continue working in partnership with our partner GP practices across the homes. A fundamental requirement of meeting the GSF accreditation standards is to demonstrate a multidisciplinary approach. Working in this way, we follow best practice guidelines and work collaboratively with our fellow professionals. This, in turn, impacts upon our colleagues in the NHS as we manage expected deaths effectively in the Care Homes thus reducing costly hospital based care.
• Providing person-centred care: Putting the people using Brunelcare’s variety of care and support services at the centre enables a person-focused and evidence-based framework of excellence to exist. The challenge, moving forward, will be to maintain and develop this framework so that more people can benefit.
• We evidence the innovation and impact delivered by the role of Brunelcare’s new Health & Wellbeing Officers, initially funded by Bristol City Council’s ‘Supporting People’ pilot scheme. This helps our 1,000 sheltered housing tenants to gain better access to the range of health and social care services available to them from Brunelcare, the NHS and their local community.
• Management challenges for Brunelcare charity to progress integration are significant in terms of the resources required – in terms of people, time and money. In this respect, we also acknowledge that high levels of collaboration are currently limited by the care sector’s funding crisis.
• Continued integrated working is key to the maintenance of excellence and the provision of seamless health and social care. Challenges and solutions can be overcome by all to ensure that people’s changing health needs are met if partnership working across the sectors is encouraged and adopted as the norm.
• Brunelcare is seen to be reducing the financial burden on the NHS, particularly the expense of hospital bed care, by avoiding hospital admissions and helping reduce delay of transfers of care. This also means more acute hospital beds are available to those most in need. For example, our Health & Wellbeing Officers evidenced a notional saving to the NHS of approximately £179,600 in hospital bed care due to the reduced hospital stays enabled for our housing tenants in a six-month period, comparing 2016 and 2017.
• In 2014, we worked with Clinical Commissioning Groups to develop Brunelcare’s Orchard Grove Reablement Centre where patients who no longer need a hospital bed but are unsafe to return home, stay and receive care and support before returning home safely. As the first ‘Reablement Centre’ created by an independent provider (and registered charity) in Bristol in 2014, Brunelcare’s Orchard Grove Reablement Centre evidences how it continues to make a difference. To get patients out of hospital in a timely manner, we ensure our beds are turned around quickly and liaise with the hospital discharge teams; our average length of stay is 41 days. We monitor delays of transfer of care, sending this information to the commissioners.
• Inadequate provision of social care. This appears to be a major issue for all the different care sectors and its impact is substantial, both on the services and their service users.
• Brunelcare acknowledges and agrees with the key findings in the National Audit Office’s report dated 8th February 2017, entitled ‘Health and social care integration’. In particular, acknowledging that we operate in a sector with a rising demand for services, and that as a care provider we are coping with ever-increasing numbers of clients waiting for a care package in their own home or waiting for a nursing home placement. We also support the NAO’s finding that expectations of the rate of progress of integration are over-optimistic. We agree that embedding new ways of working, and developing trust and understanding between organisations that work together to provide care is vital to successful integration. Finally, and this also defines Brunelcare’s approach to care, we agree that integrated care should be entirely focused on the patient’s wishes and needs.