Vulnerable older people paying price for lack of integrated care

More integrated services are required to better support older people’s care needs, says a report by the Care Quality Commission (CQC).

The health watchdog inspected health and social care services in eight areas in England to find examples of effectively coordinated care and identify barriers to its provision.

Despite a widespread commitment to deliver integrated care, inspectors found that many local health and social care leaders lacked knowledge about how to put it into practice.

RCN head of nursing practice JP Nolan said there had been much talk about improving integration of services but little meaningful action.

‘It is the most vulnerable people using the health service who are paying the price,’ Mr Nolan added.
 
‘Older people are the most likely to have multiple conditions and need access to many different services. They deserve joined-up and person-centred care.
 
‘When one part of the health and social care service starts to struggle, it has a knock-on effect, and it is patients that suffer. 

‘Integrating services is vital, and so is ensuring that all parts of the system are properly funded. Ring-fencing one part while cutting budgets elsewhere does nothing to help the most vulnerable patients.’

Key findings

The CQC's Building Bridges, Breaking Barriers report found:

• Organisational barriers made 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.
• 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 being part of mainstream service delivery.
• The monitoring and evaluation of integrated care was insufficient or not carried out.
• A lack of connection between services often resulted in older people and their families or carers taking responsibility for navigating complex local services, which could result in people falling through the gaps or only being identified in a crisis.

Budgeting

British Geriatrics Society nurses and allied health professionals group chair Clifford Kilgore suggested funding was a barrier to integration.

The Nuffield Trust’s latest estimate for 2015-16 was that only two fifths (£46.56 billion) of the NHS budget was spent on people over the age of 65.

Mr Kilgore said: ‘Budget issues are hard to overcome – we have seen a reduction in what local authorities are getting centrally from government.

‘I have been to many meetings where there has been a desire among providers to work better together, but the trouble has been in trying to do that.’

Mr Kilgore added that there is now a realisation that improved cooperation can save providers money by addressing issues such as duplication.

‘Equating improvements with financial savings doesn’t sit easily with health and social care staff; this is one incidence where saving money benefits patient care as well,’ said Mr Kilgore.

Becoming the norm

CQC chief executive David Behan said more needed to be done: ‘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,’ he said.

‘Everyone deserves seamless quality care, regardless of how many services are involved in delivering it and regardless of how complex the needs are.’

To read the Building Bridges, Breaking Barriers report, click here