For those of us working in social care, I’m sure the scenario is familiar. There is a referral from the local hospital or perhaps a self-referral to the duty desk.
The person is vulnerable, with complex care needs, is perhaps also confused or anxious about what service they need, and is more often than not, elderly. This person has been in and out of healthcare services and has been identified as needing long-term social care support. They are being referred, or have come to us so we can provide a care package – to give them the ‘person-centric care’ they most definitely need and deserve. And yet we have little to no idea what is wrong with them.
I can almost feel you all nodding your heads in both agreement and frustration. If only we had more insight into each new case that came through our doors? How much of our time might be saved, and how speedily could we provide much needed support if we didn’t have to ask people for their history, (especially when they have probably told it to several of our healthcare colleagues already)? Wouldn’t the relationships we have with our patients start off on a much better footing if we didn’t have to ask those questions?
This lack of information transfer between health and social care services is one of the greatest barriers to person-centric care in the system. Sadly, as a result, it is the person who ultimately suffers – but do spare a thought for the staff who spend too much time tracking down patient records!
Consequently, in the context of the very current debate surrounding the future funding of health and social care, one of the most important investments we could make is in a fully integrated IT patient records system for health and social care. Of course, this represents an enormous financial investment, but I firmly believe this is an investment we have no choice but to make. The sheer amount of time that staff in health and social care spend working across multiple IT systems must cost the NHS billions of pounds; money that could be spent effectively elsewhere. We are living in a digital age; tech-enabled care is one of the buzzwords of our generation so we absolutely must have an IT system that is fit for the 21st Century.
The second thing we need to think about in order to achieve better person-centric care is a move away from thinking of people as ‘medical cases’. One of things I, as an occupational therapist, am most passionate about is assessing the whole person, not just their medical need. This is true of all occupational therapists – our profession takes a holistic view and our interventions ensure people are able to carry out the activities, (occupations), most important to them. It is my view, (I may be a little biased but we are building a strong body of evidence), that occupational therapists are the key to achieving patient-centric care in the future.
For example, Kent County Council are providing a programme of enablement free of charge as part of the needs assessment to help elderly people to be more independent, placing emphasis on supporting people to build on their strengths and abilities, and not focus on activities they find difficult to do. This approach allows people to determine what activities are most important to them to achieve, offers short term support that aims to encourage and enable people to lead as independent and fulfilling a life as possible, in the way and in the place they want to live. The service often helps with things such as:
- Improving confidence after a fall
- Giving guidance in preparing meals following a change in circumstances
- Reconnecting with social activities and local communities
- Identifying equipment that could help with independent living
- Helping people to return or remain at home and feel safe and happy
Apart from potentially the first point, none of the things on this list can be termed medical issues. And yet, losing independence, social connections and the ability to live at home have major repercussions for individuals that could lead to them needing medical care – either due to mental illness due to depression or social isolation, or due to accidents in the home. Occupational therapists have a pivotal role to play in delivering the very best in social care to enable people to live independently and healthily and prevent them needing medical care except for health reasons.
Too often elderly people are taken to hospital because the system cannot care for them in any other way. For example, RCOT has evidence of occupational therapists working with paramedics reducing admission rates to hospital from 999 calls as a result of a fall by up to 76% in East Lancashire. The same service is also offering Safe and Well visits to prevent the fall in the first place. This requires integration, often vulnerable people get on the health and social care radar because of a health issue, perhaps something as simple as a flu jab.
Viewing them as a person who might have wider care needs, rather than as just the medical need they present with on the day ensures the person is treated not just the problem. A quick note in the person’s patient records and their needs and potential future areas to keep an eye on could be flagged across both health and social care teams – providing of course the IT system is integrated.
May be one day……