Vision for Community Health and Social Care: A Perspective for Collaboration between Agencies

Restructuring of health and social care is forcing many services to close or become streamlined and managers have had to find new ways to ensure they get financial support to continue services’ delivery. In the current climate of rationing services, preventative care should be re-in fenced to minimise accidents and service users’ health deterioration at home. The measure is intended to save health and social care money in the long run. By contrast, due to drastic cuts across the public sector organisations, unfortunately preventative services are often the first to be axed. This actually tantamount to negligence at core, which later challenges the existence of our prime services – to manage complex situations such as the critical and substantial care needs. Therefore, what is the rationale behind this policy decisions?

Nonetheless, it could be argued that such decisions are accredited to the tunnel vision of some senior managers. In hindsight, some of them can only see within the parameters of their corporate responsibilities that is “to save money”. In reality, it is only the older people and the other vulnerable groups in society that would suffer the consequences of such irrational decision-making. Thus, the aims of this article is to illuminate how the managers could make the case for continuing care delivery in a changing economic environment in relation to; demographic change and linear family units in the 21st Century and beyond.

On reflection, best practice would suggest that in a time of economic and budgetary constraints, collaboration with the local primary care trusts, community organisations and the third sector institutions would prevail. This would ensure that the vulnerable service users will be supported adequately to become more independent in their homes. Partnership working between agencies has the propensity for sharing resources such as, staff, information technology, offices, intelligence etc. If we are to emulate the private sector, mutualisation would help in reducing unmet needs and service breakdowns in the community. Sharing responsibilities would also promote health and psychosocial well-being among service users as well as reducing the need for admissions into nursing homes or hospital admissions.

Managing community services require organisational cultures and political change, which would give rise to the sharing of intelligence between the collaborated organisations who are working for the benefits of service users (older people, learning disabilities or mental health). This approach is intended to provide opportunities in reducing services’ duplications, costs and antagonistic relationships between agencies. Whilst capitalising on intelligence sharing, a lot of soft evidences could turn to hard evidences, this coming directly from community health practitioners such as community nurses and social workers. This data would show for example, figures on how many older people or the other vulnerable groups that were admitted to hospital after a fall or care breakdowns and what these cost the NHS and social services in after-care.

Looking at the frequency of falls and care breakdowns among the service users in a given period, the estimated figure would provide a relative forecast for the number of incidents that could lead to hospital admissions in future, costs to local primary trust and cost of care packages to social services. These results would be instrumental to future planning for community base services and implementation of strategies appropriate in reducing falls or care breakdowns at home. The projected cost savings could be reinvested to preventative services in line with continuing safe environments, where older people and other service users could be rehabilitated to minimise falls.

In practice, good risk assessments provide the opportunity for service users to be assisted in a safe environments, this could be in their own home or in a residential setting. These should be incorporated into day-to-day operations and will often run alongside equality monitoring of services. This is about getting the balance right between planning, delivery of services and managing information. This approach should be robust and prudent as to ensure cost recovery and quality care management for service users and their informal caregivers. Information gathering and monitoring of services would intensify support for community services while users are able to make choices and control of their support networks.

Another important source of evidence is feedback and “quotes from service users”. This adds to the richness of evidence. Hence, the service users know what they want and the standards they are used to, rather than the professionals prescribing for them. This signals the process for change and how services could be delivered in future. The service users and their families should be part of the new thinking in a modernising health and social care sectors and they have rights like any other citizen of the state to make informed decisions and choices.

For health and social services to remain in the premier league of services delivery within the wider welfare and universal service frameworks, it is imperative that investment in research and development is forthcoming. This provides an apparatus for good evidence based practice, where data could be shared, analysed and put to action as a mechanism in maintaining safety net. In the light of this, there is every indication that unless mutualisation is considered each of the organisations would not be able to meet the increasing needs of the growing service users now and in the future.

Inevitably, advancement in technology is changing our world and the methods of working. Thus, capturing quality practice based evidence from service users and their families could be made simple by developing and implementing scorecard systems so that individuals who come to the service can tell us things. This could be on a scale of one to five for example, telling us how depressed they feel about their care; how they feel about their health; how many falls they had in the last one month and how to improve services further. These questions or survey could be repeated every three to six months in order to compare and contrast findings. The information gathered would help determine investment in human resources and hospital avoidance strategies necessary to support older people and the other vulnerable groups to be cared for in the community for as long as possible.

All things being equal, Data Protection Act (1998) and Freedom of Information Act (2005) could constrain sharing and flow of information between agencies and this would influence services delivery in the community. If that is the case, duplication of services would continue to be present coupled with poor information sharing between agencies. In practice, duplication of services and assessment works against the best interest of the service users, hence this can create anxiety, repetition of information and exacerbation of stress amongst the users. Equally, duplication of services could lead to costs escalations between agencies and these defies the objects for cost effectiveness and strategies for recovery and business turnaround (Ugwumadu 2011).

Compliance and Risk Management: Embracing Change in a Modernising Welfare Service

Compliance and risk-management in social services is not a tick-box procedure however, it is the bottom line in service users care. The social service staff has as much responsibility as the organisation to maintain standards within budgets.

It is been well noted that social services is facing unprecedented change, focusing on four structures which are: planned; unplanned; safeguarding and procurements. This is certainly the case with the “Birmingham County Council” (May 2011) who was summon to the Court to determine the eligibility criteria matrix (DH 2002) for care needs assessment (within critical level of needs) and it lost the case on technicalities. The decision of the court was that Birmingham County Council did not consult its intentions widely to all the stakeholders.

The Court’s decision has halted drastic changes that most social services would have wished to pursue in recent times. However, the intended changes may have resulted in many challenges but, also opportunities for efficiency. One critical task is to standardise compliance to governance and risk-management requirements across the new structures and streamline the organisation’s activities. In health and social care, compliance is not just a process of ticking the right boxes and this is the difference between services to people who can make contibutions towards their well being and tragedy. Care giving has to be tailored to individual needs irrespective where the service is delivered (in the primary or secondary sector) while compliance is imperative.

Monitoring services has taken on even greater resonance with the “Care Quality Commission's” new authority to sanction and even close down services if concerns of significant risk to service users are identified. The Commission can and does turn up unannounced at any service within an NHS trust or a care home and question staff, patients and service users about key areas within the standards of quality and safety, as set out by the legislation (DH 2000, 2005). The task of ensuring our enlarged workforce and all the services provided within the NHS and social service organisations should complie with the standards. In the present time, the standards are further complicated by the reorganisations and restructuring around the departments while bridging operational and culture differences between services.

Nonetheless, developments in technology has enhanced as well as embedded a sophisticated but easy-to-use real-time quality monitoring tools; from allocation of cases, to self-assessments, inputting relevant activities in the system, and ensuring correct processes. Through the dashboard technology, managers have instant access to up-to-date information or are able to extract information and give advice to all concerned at any giving time about what assurance is available to them, gaps in services or budget constraints that exist, and what is being done about issues in question.

This level of visibility is an absolute prerequisite to running health and social care at this point of demographic change and budgetary control. Yet, it is not uncommon to work in an organisation such as social services that still relies on multiple spreadsheets with outdated information and a poor grasp of what their problem areas are. Not only are these organisations ill-equipped to cope with the changing demography, policies, budgets as well as staffing issues, transformation and redesigning of the systems, they are also impeded by an intellectual deficit to embrace business culture within the organisations. In reality, the health care and social care sectors should welcome the extra stringency being exercised by the “Care Quality Commission”. It is now empowered to help drive quality performance and safeguarding of service users care, a goal we should all strive to achieve. Equally, as long as good governance is implicit in everything we do, we need not fear its new powers.

For a long time, the NHS and social service organisations have exhausted their resources and attention by seeking to back up everything they do with documentary evidence of good practise rather than focusing on practicing budgetary management on a day-to-day basis, in the field, where it matters. To date only a few management teams have placed adequate emphasis on taking a bottom-up approach to service developments and delivery. Time has come to shift the emphasis from creating paper trails and searching for proof of protocol, to each member of staff taking personal responsibility for their actions. This approach requires a level of education for all front line staff, which will involve keeping standards in the front of their minds in everything they do.

Compliance in budgetary rules, quality assessment and care as well as risk management is paramount for the NHS and social care to survive in the current macro and micro financial challenges and increasing demand for care. Front line staff needs to be reminded that compliance is not about form filling or chasing evidence for abstract standards, it is in fact about practicing the basic standards of care every day.