Dear Mr. Hunt,
Belated congratulations on your expanded role as Secretary of State for Health and Social Care. As a leader of a membership organisation representing 34,000 professionals who work in both health and social care, I sincerely hope that this means we can look forward to genuine integration in the future ensuring smooth and flexible care for everyone.
As CEO of the Royal College of Occupational Therapists I represent a unique health professional, one that works across all aspects of health and social care. Occupational therapists working across the lifespan, from neo-natal to end-of-life care, support those with mental and physical health issues and work with people both at home and in hospital.
Therefore, I think we can say we are uniquely positioned to identify some of the challenges that you and your team will need to overcome to align health and social care.
The first challenge will be to sort out the IT systems. The sheer complexity and range of systems in place mean the patient journey from health to social care and vice versa is clumsy and repetitive. The Kings Fund report ‘Organising care at the NHS frontline’ from May 2017, identifies that key difficulties in providing the best possible care (amongst others) are: ‘Information systems that do not link data about patients held in primary and secondary care and that are often time-consuming to use; and patients having to repeat their histories (where they are able to) at different stages in their treatment.’ This is just in health – imagine how much time and money is consumed tracking patient data across health and social care? We live in a digitised world; nowadays, here in London, you can join an online GP practice, Babylon, and manage your own primary care on an app. This is where the world is going, the future is digital, and to keep up we need serious investment in a system that works, is common to health and social care and is also accessible by patients.
Secondly, we need to widen the use of allied health professionals (AHP’s) across both care systems and achieve parity of esteem for all health and social care staff. There are approximately 158,000 registered AHPs. According to the NHS Confederation, in March 2017, there were 106,430 doctors and 285,000 nurses and health visitors in the NHS, so AHP’s make up a large part of the workforce, yet they are lost in the narrative of the NHS/Care story. The evidence we are collecting as occupational therapists consistently demonstrates the value of using AHP’s like us in primary, acute and mental health services, (e.g. occupational therapists working in partnership with paramedics in East Lancashire prevent up to 76% of hospital admissions from 999 calls as a result of falls), yet solutions for the NHS crisis seem to focus on more doctors and nurses as opposed to better use of a wide range of professionals who are consistently demonstrating value for money and effective care. This is not to say we don’t need doctors and nurses, of course we do, but they would have more time to do their job and be less pressured if more AHP’s were deployed across a broad range of health and social care services.
Thirdly we need to start celebrating our health and social care system – it genuinely is one of the best in the world, yet in true British fashion we focus on the bad and fail to celebrate the good that is happening on a daily basis across health and social care. There are exciting innovations happening in the NHS, our Improving Lives Saving Money investigations have found truly brilliant partnerships in health and social care. We have occupational therapists working in GP practices to identify high-risk patients and help them reduce the risk of hospital admission through home and lifestyle adaptations; we have occupational therapists working with people with dementia to maintain good quality of life and to prevent the development of further health problems from inactivity and anxiety; in Norfolk, we discovered the case of one 80-year-old lady who called 999 twenty times in one year, yet since occupational therapy intervention, she has needed to call only twice and has not been admitted to hospital on either occasion.
I hope you don’t mind me sharing my thoughts – and they are my thoughts – informed by the members I represent and the evidence I see on a daily basis. If I was to summarise it, my advice is to create the conditions in the NHS where collaboration and sharing is nurtured and celebrated, if you create this, then the answer to health and social care integration will naturally follow.
Yours sincerely,
Julia Scott, CEO, The Royal College of Occupational Therapists.
Read our Improving Lives Saving Money reports 'Reducing pressure on hospitals’ and ‘Reducing the pressure on hospitals: 12 months on’