The NHS Long Term Plan (LTP) published earlier this month sets out the objectives of the NHS and the changes required to meet the health needs of the population for the next 10 years or so. It is rightly an ambitious document covering all aspects of the NHS.
The vision of integrating the various parts of the NHS and the implementation of the many technological solutions to healthcare problems is inspiring, but there is no denying it’s a big job.
One of the stated objectives is to ramp up NHS support for those living in care homes.
In September 2016 NHS England published a framework for working with care homes to deliver joined up care from primary, community, secondary and social care. The framework was developed with and used in ‘Vanguards’ around the country with the aim of improving the quality of life and care of those living in a care home environment.
Various obstacles to the provision of care were recognised in the framework. These ranged from - funding barriers, including the difficulties encountered in recruiting and retaining appropriate staff, to barriers in care delivery, such as a medically focussed rather than holistic patient care and lack of continuity of care.
The care model aimed to ensure enhanced access to primary care services, alignment of budgets, the concept of an integrated team working across primary, community and mental health services, as well as specialist and voluntary provision. This model has been successful in areas such as Nottinghamshire where those residents within the Vanguard had 29 percent fewer attendances at Accident & Emergency and 23 percent fewer emergency admissions than a matched control group.
In addition to these measures the LTP advocates support for care home residents from a range of therapists and others in facilitating rehabilitation and the provision of regular reviews of medications by pharmacists plus support to ensure oral health. The LTP envisages this model being rolled out across the country as staffing and funding grows.
There is recognition within the LTP of the high level of dementia sufferers in care homes. Approximately 70 percent of those residing in care homes are said to suffer from the condition or from severe memory problems. Funding for research into the condition is set to double between 2015 and 2020 with £300 million of government support.
The plan also details a series of initiatives within the community both to prevent and detect illness sooner and rehabilitate patients more effectively, enabling them to stay in their own home for longer. The use of technology is highlighted throughout the report to aid identification of those at risk eg by means of wearables measuring vital functions and recording ECGs, AI and digital access to services.
The objectives of the LTP in terms of coordinating care will no doubt gather wide support. The need to coordinate care provision from a range of somewhat fragmented agencies in the community and within hospital has been well recognised over the years. However, one can see, as touched on in the report, the potential difficulties which may be faced in implementing the plan fully, particularly in terms of staff recruitment and retention which is a particular challenge for the care sector.
Mechanisms to develop procedures and various policies, by which care provision is organised across the various agencies, will inevitably need to be formulated and introduced.
Funding the roll out is bound to be another obstacle although there may well be significant savings flowing from full implementation of the plan. Whether they are enough to meet the significant challenges in this sector remains to be seen.