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Bed blocking highlights integration problems


Analysis: Headline issue from Carter Review shows that progress in integrating health and social care systems has been frustratingly slow

Bed blocking was one of the big themes picked up by the press on last week's publication of Lord Carter's review of the operational efficiency of the NHS. There is a vivid and disturbing story in highlighting the plight of patients stuck in hospitals because no-one is quite ready to take charge of their care, while others in need of a hospital bed are kept waiting.

What the press reports generally failed to highlight was that this can happen because the patient needs social care when leaving hospital, but local social services are unaware or ill prepared to pick up the case. The limits of integration between health and social care are letting patients down and undermining the efficiency of both sides.

The barriers are well known. There is a big technical challenge in securely linking up information systems, but an even larger one in the structuring of datasets so they make sense to both sides, and establishing the limits to access.

The cultural resistance, a defensive sense of ownership towards the data in many quarters, is also a big one to overcome.

It's a problem that's been acknowledged for a long time – the Coalition Government published a policy document on the issue and it influenced the Care Act 2014 – and one in which the digital element is a key to the solution. Coordination between health and social care is only going to be achieved when people from both sides have shared access to patient information.

Fragmented developments

But the approach to develop solutions has been fragmented. Over the past few years there have been some initiatives to lay the ground for integration, but they have largely been at local level. The integration pioneer projects, begun in 2013, are localised; the Tri-borough grouping in London has worked on integrating health and social care data, the Welsh Government has funded the Community Care Information system with an initial focus on Bridgend; the Leeds Care Record has been built by the city council with local NHS trusts; and a few days ago Islington Council announced a deal with BT for a hosted interoperability service.

These are all commendable, but nationwide progress is slow and patients, hospitals and social care departments continue to suffer the consequences. Given the localised delivery of care an overarching national solution may not be on the cards, but there is a need for a framework that provides the basis for local solutions.

There are good signs. The impending replacement of the NHS N3 communications network with the Health and Social Care Network in 2017 will provide a boost, and the Government's Spending Review promised an expansion in the Better Care Fund to support integration.

It also said that every part of the country should have a plan for integration by 2017, and implement it by 2020. It plays up the potential in devolution, pointing to Greater Manchester, for accountable care organisations, and for the role of lead commissioners who would control relevant spending for both.

But it steers clear of saying how the NHS and councils should deliver, emphasising the differences rather than similarities. Given the tightness of resources, it will be a struggle for many NHS bodies and councils to develop their own solutions before the deadline.

Platform possibility

A possible way forward is the development of a platform, or series of platforms, that could be replicable as care record systems on a wide scale – something related to what the Government Digital Service is doing for central government. Maybe some of the existing initiatives would provide the basis, but they would need support from the centre to make the solutions re-usable.

Or it might be a framework of standards for systems development, using widely used data structures and access protocols for both sectors as the basis for integration. It would need an organisation, a likely collaboration between national bodies from NHS and local government sides, to ensure the standards are fit for purpose and provide the guidance for their use.

IT industry association tech UK has already provided the beginnings of these possibilities by publishing an Interoperabilty Charter for health and social care systems and pressing suppliers to sign up. But it needs a wider effort with governmental support to make a difference.

Easy? No. Realistic? It could happen, if the Government shows the will. Successive administrations have acknowledged the importance of integrating health and social care, but it has not been at the top of their agendas for the NHS or local government. It would do a lot to ease the problems of both if it was approached with more urgency.

Image by Leon Brooks, public domain, via Wikimedia Commons

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