Despite a great deal of effort from providers and policy-makers, effective health and social care collaboration that delivers good care for older people remains an elusive goal in most parts of the country.
Our new report, Managing the hospital and social care interface, highlights areas across England that have successfully bridged the notoriously challenging interface between hospitals and social care. In it we share key enablers and barriers for better collaboration and distil advice from the wider sector, all in the name of learning from each other’s mistakes and avoid reinventing the wheel.
Earlier in our project, we outlined the rules of engagement for hospital and social care partnership working, as suggested by health and social care leaders themselves. They were most frustrated by a lack of communication and close relationships between their local peers, and called for collaboration with intent, not just on paper.
They also pleaded for leaders to think beyond their organisations’ four walls, and assess the potential impacts of new interventions across the whole local health and social care economy, as risks and repercussions for partners can be underestimated. And finally, they emphasised the importance of engaging frontline ‘doers’ in transformation – the building of working-level relationships is just as important as top-level collaboration.
Easier said than done
But this is all of course easier to discuss than actually do. Integration has been a policy objective for decades, yet fast forward to 2018 and STPs, integrated care systems and numerous other service-specific networks are still trying to work it out. And if we think integrating health organisations has been difficult so far, bringing together health and social care organisations with their differing ethos, service objectives and funding mechanisms is an even bigger challenge – particularly in today’s context of stretched budgets and workforces.
In our report, we wanted to highlight strategies that local areas are using to surmount these challenges in real time. We looked at areas where entire health and care economies were jointly preventing avoidable admissions to and delayed transfers from hospital, and initiatives in which health commissioners were managing social care service provision contracts. We also spoke to areas that had chosen to undertake full integration of funding, contract management and service provision.
Approaches varied across local areas. Some initiatives used Better Care Fund monies, and others aligned smaller local contracts. Some required extensive contractual changes, others a commitment for leaders to support staff to work differently.
Most interventions relied heavily on technology, despite all areas seemingly experiencing ongoing problems with information governance and data sharing.
An important finding across all sites was not to underestimate the power of incremental changes and small wins in helping to maintain motivation and enthusiasm in the workforce, and inch towards the longer-term goal of better collaboration. Other overarching lessons across sites included:
1. Think imaginatively about how to overcome staffing challenges, beyond simply paying for travel. Perhaps make it easier for staff to do home visits (provide priority parking, for example) or develop incentives to bring new staff into the sector (such as subsidising accommodation in communities where staff are needed).
2. As alluded to above, where partnership working has been agreed, be sure that you make decisions jointly and think about risks for all partners.
3. Be clear about what you’re trying to achieve in integrated working. Weigh the benefits and challenges between long-term organisational integration and the quick but sometimes temporary gains that can be made by service-level integration.
4. Consider pooling budgets from national pots as well as local contracts to facilitate progress. It may feel risky, but a steady budget helps maintain continuity in a plan.
5. When developing integrated service delivery teams, make sure that they have consistent processes, shared understandings of each other’s strengths, and sufficient management support to see them through the possible ups and downs that come with complex service delivery.
6. Make sure that commissioners are on board – their engagement and buy-in can make or break even small integration projects.
7. Think about including housing partners in integration projects, as the goals are often aligned between sectors.
Dependent on each other
In our report we also summarise a number of challenging recommendations for national policy-makers, which essentially ask for a move beyond the focus with delayed transfers of care and call for a true equivalence between health and social care, not only in name but in funding and leadership too (let’s see what the newly rebranded Department of Health and Social Care can achieve…)
Overall, the health and social care sectors are inextricably linked and so completely dependent on one another for success. The boundary between the two sectors is challenged every day by the flow of patients between services, meaning that the quality and appropriateness of the care received in one area will have consequences for the services required in the other. With the rising challenges in finances and staffing, better collaboration is needed more now than ever.
Kumpunen S (2018) "Successfully improving the interface between hospitals and social care", Nuffield Trust comment. https://www.nuffieldtrust.org.uk/news-item/successfully-improving-the-interface-between-hospitals-and-social-care