Joint working between Health and Social Care - First part letter to newspapers

Letter

Dear Editor,     After four years as the portfolio holder of Adult Social Care for Cornwall Council I have had a great insight into the effects of the governments spending review has had on service provision.   I feel very honoured to have worked with so many hard working people from the director to care worker who contributed to delivering a more efficient department and finding savings in many areas.   Over a 9 month period last year the demands on Social Services in Cornwall grew 4% month on month which has added immense pressure on the workload of the staff and a budget overspend which will in my view not decrease in the future with Cornwall's demographics.  In the next spending review the pressure on Council spending will get even greater and this will exercise even greater pressure on their spending power which will add to a pressure on the spend on Social Care.   

With the local health service it is no different, the proposed call 111 line did not happen, there have been delays at A and E cancelled operations etc etc.  It is obvious that they system is under great pressure yet health and social care deal with the same people every day and there should be greater links between the services and an integration of the money and services available for Cornwall.  It's about time integration of health and social care become a reality to deliver a single budget and service for Cornwall that meets the demands places on it for all the residents.

But where to start, with a budget of over a billion pounds across all the organisations but are we getting the best use of this money and are we using the available staff and buildings to maximise output of services.   Are they delivering value for money and delivering services needed closer to home and in a way that uses resources in the best way.  Currently we have great capacity in our community hospital for services to be delivered including operating theatre capacity.    The following are my views and should be considered as a starting point

Firstly i would have a joint telephone system across all the services in Cornwall that delivers directly triage calls to the right place and department, delivering the person to GPs, Hospitals and Social Care in an efficient manner 24 hours a day 7 days a week(including the current out of hours Serco contract)   This should also include Cornwall's charitable and voluntary sector who provide many services not available within the area such as befriending etc.  The current Serco out of hours service should be integrated with PCH and delivered from Community Hospitals and include an out of hours GP service with active support to the current MIU services.  This would take the pressure from A and E during the evenings but there needs to be an added radiography support for breaks and fractures.  With the best outcomes coming from keeping people out of the acute sector this would give our main hospitals the focus on delivering life saving acute services for emergency situations.  

Cornwall has been a leader in Tele Health and Care systems which is delivering assistance to people within their homes.   This needs to be taken further with video links in homes of patients to allow health and care to be monitored and provided.   Just think of someone at home during the day without transport having the ability to access a GP to take advice.   If your Care provider does not turn up and you want a back up service or a link to a out of hours service outside working hours without the cost of having to find transport especially in our rural areas.   The possibilities are endless, communications with patients with mental health problems or mobility problems phobias etc etc.  Or take it further with the provision of services from the charitable or voluntary sector, befriending, carers, bereavement and many others.  

A process that has a single assessment system, assessment form and IT delivery that allows for skilled people to access the right information about patients to provide the right services.  Reducing form filling and making staff more productive will deliver a more efficient and cost effective service for all.

The management of this would be from a board, who would manage the money from a pooled budget to meet the pressures and demands placed on it.    These people would be the current directors of the trusts and social care who would still have to meet their own responsibilities within their organisations but have the authority to move money around the system to provide the best outcomes.