A systems approach to health and care design

A more holistic or ‘joined-up’  systems approach to health and social care provision could help  transform the way these essential services are delivered and address the needs of a changing patient population | Royal College of Physicians

The Royal Academy of Engineering, the Academy of Medical Sciences and the Royal College of Physicians have published Engineering better care: a systems approach to health and care design and continuous improvement.

This report explores how an engineering approach could be applied in health and social care to develop systems that meet the needs of patients, carers and NHS staff.  It presents a framework to support ongoing work in service design and improvement in health and care.  It found that more widespread application of a rigorous systems approach to health and care improvement, has the potential to have a transformative effect on health and care.

Full document: Engineering better care: a systems approach to health and care design and continuous improvement.

 

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Reforming social care

Reform the independent think-tank has published Social care: a prefunded solution.

This paper makes the case for much more fundamental reform: replacing the current ‘pay-as-you-go’ (PAYG) approach to financing later-life care with a prefunded arrangement. Under this proposal, working-age people would contribute a percentage of their income into a Later Life Care Fund (LLCF). These pooled savings would then be managed privately, before being used to fund the care costs of those that contributed.

Key points

  • The cost of long-term care is projected to rise from £19.0 billion today to £30.5 billion in twenty years’ time.
  • The proportion of spending going to people beyond the state pension age is increasing.
  • Due to the ageing population, in the absence of reform, a 26-year old today will pay a third more in tax to fund social care than people born just ten years earlier.
  • An extra payroll tax can be introduced to fund future care liabilities. The funds would be pooled in a government fund with management outsourced to the private sector.
  • A guideline for the magnitude of the extra tax is 2.55 per cent of earnings, or £60 for the median earner.
  • Once contributors retire, their care liabilities will be covered by the fund.
  • Transition to such a funding model would require the current older population to pay more towards their care

Winter warning: managing risk in health and care this winter

Leaders of NHS trusts in England are deeply concerned about the NHS’s ability to respond to mounting pressures next winter, according to a new report published today by NHS Providers.

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Winter Warning highlights the worries of many NHS trusts that extra funding for social care, partly allocated to ease winter pressure on the health service, is not consistently getting through to the NHS.

The report sets out in detail how the NHS responded earlier this year to what many consider to be the toughest winter on record. Despite extraordinary efforts from staff, the health and care systems struggled to cope under sustained pressure.

A key factor was the sharp rise in delayed transfers of care (DTOCs), for patients who were ready to be discharged, often because of difficulties in lining up suitable social care.

The government’s response in the spring budget was to use the £1 billion of extra social care funding for the current financial year to try to reduce social care-related NHS DTOCs, and so ease pressure on trusts.

The clear message in Winter Warning is that, in many places, this is not happening.

Constructive conversations with citizens when implementing new models of care

Wicked issues – complex problems that cannot be solved in a traditional fashion – are endemic in the NHS. They are nothing new. But the current challenges facing the NHS, social care and others are arguably the most ‘wicked’ yet | SCIE

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Image source: SCIE

This report summarises the findings from a research study which sought to explore how we can better broker constructive conversations with citizens to tackle wicked issues when implementing new models of care. The research was undertaken by the Social Care Institute for Excellence, working in partnership with PPL and the Institute for Government and funded by the Health Foundation’s Policy Challenge Fund.

Integration and the shift in health and social care

This paper reveals how integration of the fields of health and social care will require organisations to break down traditional barriers in how care is provided. | Skills for Health

Long-term chronic conditions and preventable illnesses such as diabetes are on the rise and can require multiple interventions from a complex range of organisations.

These population changes mean that health and social care providers must work together to pool their skills, knowledge and resources to increase efficiency and quality of care, delivering a system of health and social care shaped around the needs of the patient.

This working paper details how workforce development plays a crucial role in successful integration.

 

‘Integration and the Development of the Workforce’  is available to download from Skills for Health

Health and social care integration

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The Department of Health has published Social work: essential to integration.  This document is intended to support and inform local and regional health and social care integration initiatives.  It explains the contribution that social workers make to integrated services; how social work is essential to the whole system; and the necessity of support to ensure integration succeeds in providing the services people need.

It also includes ‘top tips’ for directors of adult social services and for principal social workers to assist in progressing the integration agenda.

It was developed in collaboration with the Association of Directors of Adult Social Services, the Principal Social Workers’ Network and the Department of Health.

The document can be downloaded here

Total transformation of care and support

The Social Care Institute for Excellence has published Creating the five year forward view for social care: how transformed and integrated health and care could improve outcomes and cost-effectiveness.

This updated paper explores the potential for scaling up the most promising examples of care, support and community health services, initially using data from Birmingham City Council, modelling their outcomes and costs.  Originally published in November 2016, it has been updated to include additional models.

The report contains the following chapters:

Vision for transformed care: Re-shaping services around the needs and strengths of individuals, families and communities.

Key messages and summary: Outcomes can be improved, and costs reduced, if the sector scales up promising practice.

Case studies: Six models of care and their potential impact on costs and outcomes.

Models of care: Overview of promising practice that support transformative change in health and social care.

Conclusions and next steps

The paper is available to download here