Health and social care – right direction of travel but concern over lack of resources in place for changes
Doctors at the BMA’s annual conference in Bournemouth today (Monday 26 June) have called on politicians from all parties across the UK to stop raising false expectations regarding what integration of health and social care can achieve when it comes to reducing the admissions of elderly patients to hospital.
Doctors voted overwhelmingly in favour of supporting the principle of health and social care integration. But they called on government to provide enough hospital beds and social care to meet demand, acknowledge the need for adequate additional funding and for an open dialogue with the public and patients about what services the NHS should provide for the funding available and what services can no longer be provided by the NHS.
The debate was led by Dr Peter Bennie, a consultant psychiatrist working in the west of Scotland, and chair of BMA Scotland.
Proposing the motion he said:
“I’m a consultant in general adult psychiatry and for a quarter of a century I’ve been working in multidisciplinary teams with nurses, social workers, occupational therapists and psychologists. It’s what I do, it’s who I am, integration is a key part of my clinical work and has been for a long time.
“I started my psychiatry training in Glasgow in the early 1990s - a genuinely exciting time as we embarked on a full programme of deinstitutionalization and a move to community care. Money and staff flowed from huge psychiatric hospitals to new expanded community teams and to supported accommodation projects. This worked. It worked because health and social care staff came together to make it work. And it worked because it was properly funded with bridging finance so that community services were up and running before the wards closed.
“Right now, there’s a general sense amongst most doctors that integration is probably the right direction of travel, but there are also real worries about the implications of such significant changes when health budgets are extremely tight and the social care budget even more so.
“Factor in our medical workforce problems with consultant, specialty doctor and GP posts lying vacant across the UK and it’s clear that these may not be the opportune conditions for a widespread re-organisation of health and social care. Perhaps the greatest medical workforce concern is that recruitment into training posts is poor in several specialties - and that includes, crucially, general practice, at a time when we expect retirement rates to rise.
“Here in England, the National Audit Office published a report in February on the experience of integration so far. Its key messages are arresting. The report speaks of over-optimistic expectations of the rate of progress, saying that it can take many years to amalgamate cultures and working practices; and it seems to me we’re already seeing this play out in Scotland.
“The report draws specific attention to problems with incompatible IT systems and reluctance to share information between health and social care staff - again this is ringing bells for me. At my workplace we still have problems even between in-patient and community mental health arms of the same service, never mind across to primary care, never mind across to social care. And, most crucially, the report concludes that the existing evidence base does not yet support the proposition that integration saves money, reduces hospital activity or improves patient outcomes – and that, too, chimes with the experience of doctors.”
Commenting on the debate, Dr Peter Bennie, chair of the BMA in Scotland, said:
“Each part of the UK has its own interpretation of how health and social care integration can be delivered. But what is clear is that whilst there is agreement that it is broadly the right direction of travel there remain significant concerns about the need for adequate funding and resources to deliver this policy effectively.
“New services in the community need to be properly up and running before the current in-patient services can safely be reduced or closed.”
The motion in full read as follows:
* 12 Motion by THE AGENDA COMMITTEE (MOTION TO BE PROPOSED BY THE SCOTTISH COUNCIL): That this meeting:-
i) supports the principle of integration of health and social care;
ii) calls on politicians from all parties UK-wide to stop raising false expectations regarding what integration can achieve when it comes to reducing the admissions of elderly patients to hospital;
iii) calls for government to provide enough hospital beds and social care to meet the demands being placed on these services;
iv) calls for government to acknowledge that this cannot be done properly without adequate additional funding;
v) calls for government and NHS lead bodies to have an open dialogue with the public and patients about what services the NHS should provide for the funding available and what services can no longer be provided by the NHS.