Could better care outside hospital save cash in the long run?

Should health and social care services be more focused on supporting people at home?
Should health and social care services be more focused on supporting people at home?

Three quarters of the predicted increase in the cost of individual “care episodes” across Lancashire over the next decade could be offset by investing in efforts to keep people living independently at home – or get them back home quicker after a stay in hospital.

That was the conclusion of a report into the region’s intermediate care system, which provides support for people who are at risk of being admitted to hospital and for those who need extra help to be safely discharged.

The changes would mean that the health and social care system in Lancashire and South Cumbria would be spending an additional £28m on care in ten years’ time instead of an extra £115m under the current trajectory.

But a meeting of the Lancashire health and wellbeing board heard that the changes needed to achieve the saving would require the number of staff currently working in the intermediate care sector to be more than doubled to over 1,700 in the same timeframe.

“This is a considerable financial opportunity, but the biggest challenge is where we [will find] the workforce,” Tony Pounder, Lancashire County Council’s director of adult services, said.

“But if we do nothing, then total spending will increase from £456m to £571m – and where we will get that money from, I’m not sure.”

The suggested new model would see staff doing “everything they can” to keep a person at home and creating an integrated system which allows staff from the NHS and social care to create “wrap-around” support for patients depending on their individual needs. It would build on existing programmes like Home First, where patients are sent home for an assessment of their support requirements rather than waiting in hospital for it to be carried out.

The report predicts that the acute care sector would be the biggest beneficiary of any overhaul. The bill to hospital trusts for looking after patients who would be eligible for intermediate care would actually fall by £38m over the next decade, rather than increase by £51m under the current scenario.

However, Lancashire’s director of public health Dr. Sakthi Karunanithi warned that there needed to be a “definite plan” for the investment required to make the necessary changes. The meeting heard that money would have to be moved around the health and social care system in order to make the plans work and that any changes would be phased in over four years.

Members were also told that the current intermediate care arrangements are fragmented across the region – and the outcomes for patients mixed.

Sue Stevenson from patient group Healthwatch said the litmus test of the policy would be the response of those who had been treated under it.

“People have to believe that staying at home is the best thing for them and that means they have to experience the very best care at home. Until somebody who has gone through it tells [others] the story that it worked for them, then the model will not be as effective as it needs to be,” Ms. Stevenson said.

There are various types of intermediate care operating in the region – from bed-based rehabilitation centres to so-called “reablement” teams providing support in people’s homes.

Current intermediate care programmes are funded by two similarly-named pots of money. The Improved Better Care Fund is new cash from the government which has been worth a total of £46m to Lancashire since it was introduced in 2017, but which runs out next year.

The Better Care Fund is a policy whereby NHS and local authority organisations pool parts of their existing budgets for the purpose of integrating care. More than £60m was shared across the two sectors in Lancashire during 2018/19.