It is time to rapidly shift our focus onto the primary, community and social care frontline to make our vision for integrated care a reality, writes Conor Burke
We have seen more transformation of health and care services in the last four weeks than we have seen in over four decades of integrated care policy initiatives.
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Covid-19 has driven some fantastic examples of joined-up working across the NHS and local government, with herculean efforts and rapid innovations deployed at pace to rapidly safeguard patients and support staff.
In a matter of days national bodies have been able to quickly remove legislative, policy and organisational barriers that have tormented us all for many years. We have seen the suspension of the payment system, the removal of continuing healthcare assessments, the redeployment of staff to focus on those most in need, the full adoption of digital technology in primary care and the rapid redesign of some key services within weeks.
We have remembered the importance of data and evidence, the critical role served by public health to inform priorities and action and how councils are the leader of community resilience and place.
Mortality rates
And yet while there is much to celebrate, covid-19 has sadly exposed deep gaps in how we deliver integrated care. This is best demonstrated by HSJ’s recent analysis of mortality rates both in and out of hospital over the first two weeks of April.
In care homes, there were nearly double the average number of deaths, and in people’s own homes there were 70 per cent more deaths
It showed that there were fewer people who did not have coronavirus dying in hospital than would be expected for the first two weeks of April. But in care homes, there were nearly double the average number of deaths, and in people’s own homes there were 70 per cent more deaths.
There is increasing evidence that the rapid discharge of people into the community without appropriate testing, when combined with the inadequate protection of staff, has potentially transferred the risk from hospitals to primary and social care and to the most vulnerable in society.
The pressure is going to continue to grow. Recent data has shown a 50 percent drop in hospital activity and virtually no elective activity is happening currently. This will have created a significant backlog of demand and increased morbidity for people in the community. Even when work is restarted it will take the NHS considerable time to recover the position leading to significant pressure on community services.
The NHS acute sector has done a heroic job to create capacity and to save lives but now is the time to rapidly shift our focus onto how we support, invest in and empower the primary, community and social care frontline to finally make our vision for integrated care a reality.
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