Ian R. Smith 29 September 2015

The misalignment of health and social care

There is a looming crisis in health and social care. The UK’s care systems are misaligned with the needs of today’s society. They are wasting public money and the country cannot afford to sustain the inexorably rising demand in the long term. There is an urgent need for reform to an integrated health and social care system.

That is the case set out in a pamphlet that I have co-authored with my brother Stephen K. Smith, who is a professor of Medicine and set up the first academic health and science centre at the Imperial College Healthcare NHS Trust in 2007.

I am chairman of Four Seasons Health Care, the UK's largest independent health and social care provider. I have also been CEO of a group that operated nearly 70 private hospitals and I have had a book and articles published on health reform.

The UK model of care was created in 1948 when the epidemiology of disease, social policy and people’s lives were very different from today. Advances in diagnosis and treatment mean people are living longer. With an ageing population comes a rise in chronic long term conditions, people with co-morbidities, increasing demand for longer-term elderly care including dementia care. There is an increase in ‘lifestyle’ diseases such as obesity and in the need for improved care for mental health in the community.

But the health and social care systems have hardly changed since they were set up 67 years ago.

Consequently, despite our having world class medical sciences and clinicians, we have some of the worst health and social care outcomes in the developed world.

There is a funding imbalance that produces a spiral effect whereby money is directed into the NHS to meet a burgeoning need, whilst the lack of funding for social care means that more demand flows into the NHS with the ‘back door exit’ to care in the community being partially closed. This is actually increasing costs in the NHS. For example, an estimated third to 40% of hospital beds are occupied by people long after their medical condition has been stabilised.

To avoid a deepening crisis the country needs to move to integrated care organisations (ICOs) that will remove artificial boundaries between health and social care and between different parts of the healthcare service such as acute and chronic medicine, treatment and preventive interventions and physical and mental health.

Within hospitals, advancing medical science and practice requires greater clinical specialisation. While the integrated care organisation would need to draw on a balance of specialists and generalists, there is a strong case to consolidate the available specialist expertise in cardio, cancer etc into centres of excellence. This will mean fewer but larger clinical units.

Instead of the conventional GP surgery, the holistic approach to care would require larger health centres in which GPs would be co-located with social workers, mental health experts, pharmacists and diagnostic technology.

We need to complement the ICOs with Academic Health and Science Centres that allow hospitals and universities to focus on clinical excellence by building competencies in clinical specialities and by leveraging developments in genetic medicine to advance scientific discovery at the level of ‘big data’ - and translate that into personalised medicine.

The pamphlet, which we have written in a personal capacity, is entitled: Away from the past and to a sustainable future. How the UK’s health and social care systems can be reformed to better align with the needs of today’s society.

Ian R. Smith is the chairman of Four Seasons Health Care

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