Poor health and social integration denies elderly of personalised and effective care

Older people are denied effective, personalised and responsive care due to poor integration across local systems, according to a new report.

The Care Quality Commission’s (CQC) report, ‘Building Bridges, Breaking Barriers’, has warned that despite a widespread commitment for integration across the sectors, substantial progress is needed to better support people who use a number of services, reduce hospital admissions and to avoid confusion about where to go for help.

CQC’s chief executive, David Behan said: “Older people who use health and care services tell us that they want their services to be joined up and work together.

“This study found examples of effective integrated care but these small steps need to become significant strides to move joined-up services into the mainstream. Everyone deserves seamless quality care, regardless of how many services are involved in delivering it and regardless of how complex your needs are.

“Local leaders should build on the opportunities offered by initiatives such as the new care models vanguard programme to deliver joined up care.”

’Fragmented care’

The report highlighted that with an ageing population in the UK, older people typically have the most complex needs and receive care from more than one service, often across multiple locations.

CQC inspectors gathered evidence from a range of sources, including speaking to older people and their carers to understand their experiences. They inspected services within eight areas across England to look for examples of effectively coordinated care and to identify barriers which prevent care from working well.

They found that people with complex needs, who use a range of services, are satisfied with individual providers but when they move between different services, their care can become ‘fragmented’ and can have an ‘adverse impact’ on their experience of using care.

The report highlights that ‘substantial progress’ is needed to achieve the collective ambition that individuals receive joined up, personalised care and support.

While inspectors found widespread commitment to deliver integrated care, local leaders such as directors of adult social services, health and commissioning managers, appeared to lack the knowledge about how to put it into practice.

’Lack of consistency’

They also reported organisational barriers that make it difficult for services to identify older people at risk of deterioration or unplanned hospital admission in a timely manner, including a lack of consistency in the use of assessments and sharing information.

Similarly, many initiatives to encourage and enable joint working were inconsistent, short-term and reliant on partial or temporary funding and goodwill between providers rather than part of mainstream service delivery.

A lack of connection between services often resulted in older people and their families or carers taking responsibility for navigating complex local services, resulting in people ‘falling through the gaps and only being identified in a crisis’.

Inspectors found that where care was integrated, local leaders were working closely across health and social services to share information, reduce duplicated efforts and use resources more effectively. A number of initiatives, strategies and systems offered an opportunity to deliver coordinated care in local areas.

’Financial pressures’

The report has recommended local health and social care leaders to agree a shared understanding and definition of what integrated care means for their community.

It has also urged NHS England and the Association of Directors of Social Services (ADaSS) to develop an agreed methodology at a national and local level across health and social care to identify people at risk of admission to secondary care or deterioration.

Older people should also be meaningfully involved in making informed decisions about their care – in particular about the outcomes that are important to them.

Responding to the Care Quality Commission's report, a Local Government Association spokesperson said: “There are many examples where local health systems are integrating to the benefit of older people in need of health care and support. However, to really ensure that individuals receive the care they need and deserve, we need social care to be properly funded by Government.

“Despite the financial pressures faced by local authorities, councils and their partners want people's needs and wishes to remain central to their care.

“Councils, care providers, charities and the NHS are all united around the need for central Government to fully fund adult social care as this is vital to ensure our loved ones enjoy the dignified and independent quality of life they deserve.

Integrated care

“As a starting point, the Government should bring forward £700 million of desperately-needed social care funding earmarked for the end of the decade to allow councils to protect vital social care services essential to easing the pressure on care providers and on the NHS.”

Commenting on the findings of the report, Professor Gillian Leng, deputy chief executive and director of health and social care at The National Institute for Health and Care Excellence (NICE), added: “This CQC report highlights the need for better, more integrated care for older people.

“As our ageing population grows, we need to make sure that the most vulnerable people in our society receive the best possible care, and that is why we support this call to action. The time to act is now.

“Our guidance, ‘Older people with social care needs and multiple long-term conditions’, calls for services to work more closely together so that older people can get better and stay better. We are producing a quality standard (QS) of this guideline which should help support CQC’s work in this area.

“By working together across health and social care, we can ensure that older people receive the joined up care they deserve and need.”

For more information, visit: http://www.cqc.org.uk/