Caught in the middle

The key interfaces between health and care are where professionals should focus their attention

I’ve been at The King’s Fund for almost six months now. My time here has really flown by. In truth, I was nervous about joining an organisation with such an amazing reputation in health policy with a background in social care and local government.

Two things have eased my anxiety. The first was the welcome and generosity my colleagues have shown me. The second is the confirmation, through our research work with the Nuffield Trust, that the planning and delivery of social care and health services (and indeed housing and benefits) are so interlinked that maintaining incentives for the different ‘systems’ to compete is utterly counterproductive.

The most obvious and measurable sign of pressures to both community NHS and social care budgets is in the admission to and timely discharge from hospital of older people. Over the past few years, the data shows us that delays due to waiting for health or care packages in the home have increased over and beyond delays for any other reason.

Local authorities, care providers and the NHS in many areas are trying to solve these delays, but shortages of staff facing both sectors and pressures on residential and home care are taking their toll. This is all made worse by the massive pressures on primary care as well as the uneven distribution of intermediate care beds. Anecdotally, district nurses would often pick up the slack in ‘social care’ and home care workers would do the same in ‘health’ where needed, regardless of who was paying. When both are stretched, it is people with real need that suffer.

Squabbles over NHS continuing healthcare assessments, shared packages, Section 75 agreements and safeguarding all play a part in undermining relationships and leaving people who need support stuck in the middle. Local areas must focus on these pressure points and prioritise the person despite the instinct to fight over money and responsibility.

Getting these key interfaces right can make a massive difference to individuals. My granddad Mick was recently stuck in hospital for weeks waiting for a package of health and care while he lost strength and grew increasingly frustrated with being what he considered imprisoned. I won’t repeat some of the colourful language he used to describe the ‘system’ we have allowed to emerge. But now he’s home, he is being supported by a home care package, working with my family to live life on his own terms, which may or may not include the odd pint and a rendition of ‘Among the Wicklow Hills’.

The King’s Fund is creating a space for stakeholders at the interface between care homes and the NHS to come together and discuss how to tackle these issues. If you are interested in getting involved, sharing experiences and being facilitated by our fantastic team here at the Fund then contact Tracy Nottage on 020 7307 2593 or email to set up an initial call with one of our team about applying to join the network.

Patrick Hall

Fellow, Social Care Policy

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