Click to listen highlighted text! Powered By GSpeech

Home » Posts tagged 'integrated'

Tag Archives: integrated

Thanks to Andy Burnham for emphasising “care co-ordinators” which I feel are pivotal to living well with dementia



This morning I had a present for Andy Burnham MP (@andyburnhammp), about to lead the Labour troops into battle for the European elections. The present is of course a copy of my book ‘Living well with dementia’, which is an account of the importance of personhood and the environment for a person living with dementia.

12

Marathon

 

In my article entitled “Living well = greater wellbeing” for the ETHOS Journal (@ETHOSJournal), I highlighted the critical importance of the ‘care coordinator':

So, if one had unlimited funds, what sort of service could be designed to provide care and support for people with dementia? In my opinion, the answer is a very different one. Ideally, all services, which could include healthcare, housing and legal systems, would adapt quickly and flexibly according to the needs of the individual living with dementia. This would need to be managed by a named, long-term co-ordinator of care and support.”

In reply to my article, Paul Burstow MP commented helpfully:

“The idea of a care navigator able to call on and coordinate all available health and social care, as well as housing support and voluntary sector provision is a persuasive one. It is something that the Richmond Group of charities, among others, have for a long time called for – and it is something I would like to see the Liberal Democrats deliver in the next government. Better managed and coordinated care would be a huge step forward and could make all the difference to dementia sufferers and their often strained carers.”

And Andy gave it much prominence this morning:

The King’s Fund (@TheKingsFund) has previously looked into co-ordinated care for chronic conditions.

In this framework, a “care co-ordinator” acts as a single point of contact and works with the patient, their carer(s) and the multidisciplinary team to develop a care plan.

Once this has been agreed, the co-ordinators work with the team, the patient, the patient’s family and other care providers to deliver co-ordinated and coherent care. Personal continuity of care is actively encouraged, and the care teams work hard to ensure an immediate response to care needs as they arise.

The care co-ordinator becomes he patient’s advocate in navigating across multiple services and settings ??providing care directly in the home environment.

He or she also ??communicates with the wider network of providers (outside of the core multidisciplinary team) so that information about the patient/carer is shared and any actions required are followed up.

The King’s Fund has previously found that the type of person undertaking the care co-ordination function varied greatly.

Most care co-ordinators had been community or specialist nurses, yet the role has also been taken on by non-clinical ‘link workers’ (in Sandwell) and health and social care co-ordinators (in Torbay).

There also appears to be a continuum from the non-clinical approach – primarily providing personal continuity to service users and acting as their advocate to ensure that care is co-ordinated around their needs – to the clinical approach, in which a case manager would also be able to provide clinical care directly.

This, I feel, is significant, as my book ‘Living well with dementia’ has a very non-medical thrust.

It’s very much a n0n-authoritarian, non-hierarchical approach where each person, including the person living with dementia, has an important part to play.

Influences on someone living well with dementia might include design of a home or ward, assistive technologies, ambient-assisted living, “dementia friendly communities”, for example.

With the introduction of ‘whole person care’, it’s possible that the care co-ordinator for a person living well with dementia might become a reality.

In this construct, Andy Burnham MP, Shadow Secretary of State for Health, is trying to stop the overhospitalisation (and overmedicalisation) of people.

Selling integrated care on the back of austerity will be a big political mistake



George Osborne

Andy Burnham, Shadow Secretary of State for Health, famously told the New Statesman fringe meeting last year, “It’s the economy stupid, but don’t forget about healthcare”, quoting the celebrated US election aphorism. There are many groups which Labour could choose to harness in the 2015 general election who feel they have been disenfranchised. This might include the NHS workers who saw their automatic pay rise disappear today, and who collectively have been feeling the pressures of a £2bn reorganisation which they did not request for. Also disabled citizens do not have any particular reason to like this government, with many welfare benefits decisions made by ATOS being overturned by appeal.

Austerity itself is a policy which is recognised by public health physicians to have had a detrimental effect on individuals’ psychological wellbeing. While austerity might test the mental resilience of people in current economic times, there has indeed been an academic debate about the impact of austerity on mental health in general, including the incidence of suicide in European countries. The Health and Social Care Act, in addition to being a voluminous and complicated piece of legislation, suffered some fairly textbook reasons in management of ‘barriers to change’. One was the often cited reason that the NHS is ‘inefficient’, howsoever that is measured, given that the NHS is actually one of the most efficient healthcare systems in the world, according to official data. Also, the business case for the change is not particularly compelling. Despite price competitive tendering of contracts in the NHS likely to cause an outsourcing of legal accountability and increased total costs, the section 75 regulations as finally enacted made price competitive tendering the default option. Also section 164(2A) means that NHS entities can earn not 50% or more from private sources of income, which is a huge percentage. Private companies exist in law to maximise shareholder dividend.

To sell then integrated care on the back of a failed austerity plan is therefore ludicrous, and yet that is exactly what George Osborne did today. Osborne talked about the ‘billions’ that would be saved in ‘joined up’ care, but this is not the sole goal of integrated care. Integrated care is not simply about saving money; it should be about offering healthcare that it is most suitable for a person or patient at any particular time. Also, the language of Osborne and Danny Alexander, Chief Secretary to the Treasury, was one that integrated care would only be of benefit to the taxpayer when considering the elderly. Danny Alexander, in discussion with Andrew Neil on the BBC today, talked about the ‘potential burden of the elderly’ to the taxpayer, which is an affront to those elderly citizens who have themselves contributed much to the fabric of the UK, in tax or otherwise.

Labour will be making a mistake too if it attempts to sell integration on the back of austerity. It is unclear sometimes quite whom Labour represents, when the private finance initiative (PFI) was strongly opposed by UNISON in the early 2000s. Despite being a creation of the John Major government, Labour had embraced PFI, and Osborne has sought to improve its implementation. Likewise, the actual rationale for integrated care cannot be sold as a money-saving exercise. The country is already deeply cynical of the billions of ‘efficiency savings’, apparently on the back of cuts int he workforce of thousands, not being ultimately being ploughed back into frontline care. The admiration of Chris Ham of Kaiser Permanente is well known, but there is no reason to disbelieve that Labour has no intention of embracing ‘managed care’. The language of the ‘dementia crisis’ has been racheted up of late, and if this is combined with a general ideological attack on the elderly, the narrative no longer becomes one of how we deliver care for all of the population, but how people can make private provision for their future through private health insurance.

Whenever such a debate is brought up, it immediately gets dismissed as ‘conspiracy theories’, but a genuine debate about how integrated care is being ‘sold’ to an exhausted public needs to be had. If today’s statements by George Osborne are anything to go by, part of the ‘case’ of the Conservatives appears to be very much an economic one. While management theory has never adequately resolved how stakeholders interact in forming strategy, if the debate on integrated party gets subsumed by any particular entity this could be detrimental. Labour may be 10-15% ahead in the polls on the NHS, but even Labour cannot take its support on the NHS for granted. Ironically, as the current Government discusses how to regulate against aggressive lobbying, maybe it’s time that the “vested interests” which Osborne so confidently mentioned today come under some scrutiny of their their own regarding the formation of English health care policy?

Click to listen highlighted text! Powered By GSpeech