Integrated health and social care: a personal reflection on frontline services.

Abstract

Accessibility is a core value in both health and social care because it coincides with ordinary people's expectations - especially in situations where they believe that they are facing an emergency. When a service cannot be accessed in one location, they will go to a place where they will be seen. Accessibility is therefore at the centre of some people's propensity to choose an accident and emergency (A&e) attendance in preference to the general practitioner's (Gp) surgery or even the local pharmacy. Naturally, some of this causes an unplanned and possibly unnecessary workload that is manifested in familiar results, but it is not the only problem.recently published statistics indicate that during winter months, the National Health Service in england and elsewhere did not meet waiting time targets for A&e departments. the inferred failure is dreadfully demoralising to hard-pressed frontline staff who daily cope with the reality of vastly increased workloads which in turn have negative impacts upon related departments and inpatient services.Across the united Kingdom, it appears that major contributory factors in this crisis are many and complex. they range from some people's misplaced preferences for A&e attendance, an influenza strain that did not conform to expectation, through to growing numbers of elderly patients with varying degrees of dependency whose discharge needs can be somewhat intractable.But elderly patients resent being blamed for these problems. We must not forget their past toil in mines and mills, offices and fields, put the capital values of health and welfare in place. they deserve better.unfortunately, the policy makers and planners of yesteryear made inadequate provision for the longterm consequences of the post-war bulge in population. this has resulted in severe shortages in money, staffing and suitable estate which are required to solve these problems. the result is that discharge from hospital to more appropriate forms of care can be fraught with difficulty.over-occupancy in the acute sector while care packages are developed seems inevitable. However, such delay for even short periods of time, as well as being an unnecessary drain upon scarce resources, can have catastrophic consequences on an already fragile and over-stretched provision in other parts of the system.Closer working relationships with external facilitators such as Gps, community nursing staff, including mental health workers and local authority social services, are essential. However, in our efforts to achieve better discharge rates to more 'cost effective care packages' which must be related to dependency levels,1 we have to be sensitive to the feelings as well as the needs of elderly patients who are destined to be moved around the system.As well as dealing with the problems inherent in the internal environment, tackling external factors is essential. Better cooperation with external providers has been stimulated in no small part by the crippling pressure in A&es and that has been sustained over winter months.SeamleSS Service ProviSionin addition to care of the elderly, there are other contiguous boundaries where programmes or pathways of care are shared with the acute sector and sometimes between each element of the primary/social care spectrum. these include services for children, patients with mental health problems and patients/ clients with long-term mobility problems.Consequently, it sometimes happens that vulnerable individuals who have complex needs are not properly treated because they fall between two or more categories. in these circumstances, vulnerable patients/clients can end up in a sort of limbo land while case conferences and budget managers sort out their requirements.Beneath the umbrella of independent health and personal social service provision lies an incredibly complex array of services, both statutory and voluntary, designed to cope literally from the cradle to the grave - although nowadays sometimes pre-cradle. …