IMPOWER roundtable – Beyond reset: the future of health and care integration

Many changes implemented through Covid have been spoken about for months and struggled to get traction, yet amid a crisis they were implemented overnight. At our recent roundtable on the future of health and social care integration, we brought together colleagues from across the sector to discuss learnings from Covid and the pressures partners are now experiencing locally, and across the system.

From our discussion, it is clear that there are some positive learnings to come from Covid that need to be held onto as we go through winter preparation into delivery:

• The importance of the Voluntary Community Sector (VCS). As a system, we are now more coherent and joined up with our communities. The next step now is to set a strategy for the VCS and how we can build on that learning and integration, especially looking into winter preparation.
• We have seen much more effective system working – for example, mutual aid happening around beds.
• Frontline clinicians have been key to resolving problems. Empowering staff to be innovative and take control, particularly in older people and mental health teams, has allowed services to adapt quickly to demand.
• There has been a digital breakthrough. Telemedicine has been spoken about for years yet little progress had been made until recently. For one partner, 85% of appointments for older people went virtual within three weeks of Covid hitting, but the total volume of consultations dropped. In other cases, a pathway review identified that patients were having double the number of consultations. Virtual appointments can increase productivity and efficiency, but digital strategies must be implemented to make this cost effective and efficient.
• Incredible progress has been made on building relationships in every direction between NHS, local government, primary care, acute care etc. Acute care has moved forward in leaps and bounds, and the independent sector has worked with system partners in a transformational way. New community organisations were fundamental in looking after people shielding.

However, despite the positive outcomes of the crisis, system partners are now facing huge pressures:

• Insufficient pathway coordination. For example, waiting list discussions are taking place at secondary care level – primary care needs to carry part of the risk. As we enter winter, we must influence behaviour across the system to approach pathway demand more effectively to achieve better outcomes.
• Getting commitment around a single vision, clear direction, and focus. If one of these factors is missing, change will not be effective or sustainable.
• Tackling health inequalities. Covid has shone a horrible spotlight on health inequalities – this a big issue we must address.
• Resolving capacity issues. Insufficient ICU beds, PPE, test and trace services have been exposed – much work needs to be done to resolve these issues.
• Lack of people resource and strategic headroom. Staff have been working very hard – they are tired and need a break. We cannot rely on volunteers to offer as much time as they did in the peak of the pandemic. Pressure must be reduced to allow people to achieve achievable targets.
• Budget constraints across health and care. The systems are in a massive financial deficit which is likely to get worse in the short-medium term due to Covid. Investment money for new models of care is time limited – we must address this.
• Financial position of VCS. National statutory funding is having an impact on organisation which rely on donations, so people are being made redundant. Some are reducing their staff by 75% – several charities will go under if this funding issue is not addressed.
• Ensuring digitally deprived receive care they need. Whilst going virtual opened doors for many, some will have missed out due to technology not being accessible. Hybrid processes need to be in place.

The crisis has taught us that with a common goal, people will work together to achieve what needs to be done. Not having budget constraints during the crisis enabled health and care colleagues to think about best outcomes for people.

It is a challenging time to be working with a health and social care system, however there is a real opportunity to reduce barriers and build on constructive behaviours now. Funding will always be a challenge, but to ensure innovation and integration happens – we must give it the focus it needs. There is significant energy to innovate and integrate across health and care – we must not lose that through a testing winter.