Dr Nichola Stefanou is CEO of Healthcare Management Trust (HMT) and has spent over 20 years working across health and social care in a variety of senior leadership positions. Dr Stefanou is passionate about the integration of community services to reduce health inequalities. She previously worked as Director of Care and Clinical for Homegroup (one of the UKs largest housing associations), during which she spearheaded the development of a specialist care arm focusing on people with complex needs who needed long term health and social care input with bespoke housing in order to live within the community.
Dr Stefanou shares her three main takeaway lessons from her experience of working across both health and social care.
The health service is overwhelmed. We have an ageing population, and resources are limited. Care homes are constantly under pressure. With the cost of living in crisis, many are worried about the costs of care in later life. These are the kind of challenges that don’t go away. They don’t solve themselves.
I don’t consider myself a pessimist, but the situation is real. We have the desire for change, but can we find creative solutions that are sustainable? Is it time for radical change to address these concerns? I lean on my experience in both the health and the care sector to find ways to help us consider alternative ways to move forward.
Bring the health and social care workforces closer
Switching from acute healthcare to a community-focused setting in the independent sector was eye-opening. I felt valued and trusted inside the hospital, but I experienced something different in social care. Hospitals have their own micro-climate; separate from the communities they serve and are sometimes unaware of the work done on the ‘outside’. The social care workforce’s skills and knowledge were often underestimated and undervalued. It was a humbling and challenging lesson for me to learn.
I had to recognise the skill and knowledge outside of hospitals that social care workers could administer within peoples’ own homes and communities. Bringing the two workforces closer together will be mutually beneficial. And it doesn’t have to be complicated. It could be as simple as getting those qualifying for a care certificate to have work experience with trainee nurses and vice versa. Where from day one, we put equal value on both roles.
Shared resources, workforces and information will improve the experience for people and care providers.
Get comfortable with uncomfortable conversations
To embrace radical changes, we must flip our thinking. We should let leadership experience frontline delivery in both health and social care. Their presence will allow them to see what each do and understand capabilities and limitations. This insight will help healthcare to relinquish some of its traditional ideas and support better integration. If we can provide more interventions in care homes and communities and keep people out of the hospital, we could see more innovation, release costs, and improve quality outcomes.
We could try simple solutions like greater use of assistive technology, care assessments and connecting to hospitals digitally. Of course, there will be an initial cost to achieving this, but that’s money well spent.
Decision-makers and leaders will need to get used to feeling more discomfort to get to the point of the radical change we need. The fiscal challenge isn’t going away. But if we continue ploughing money into healthcare delivery models without any change in approach, problems will be perpetuated rather than resolved. If we flip the thinking and put social care and community first, we could make some real headway. Look at all the potentials in vacant care home beds or care homes falling out of use. What might happen if we view them as a resource to be tapped and invested in and remove some hospital activity into that setting? What positive change might we affect? Utilising existing and available resources saves funds being directed to new facilities.
Integrating health and social care systems
There are more innovative ways to release both the quality improvement and the financial benefit that the system needs. Peripheral adjustments and restructuring will not deliver the outcomes we need.
If health and social care come together, we can help each other. Could we consider moving leaders across system boundaries in a way we haven’t previously? How much might we learn by cross-pollinating and truly understanding the potential in new areas. Had I not had the opportunity to work outside of traditional NHS provision my views would never have changed or further developed.
Representation of social care is often missing in Integrated Care Boards. I have seen examples of it working well on a small scale. But isolated health and social collaboration will not achieve the radical changes we need. Social care must be included to boards and leadership. Social care must be closer to the conversation. We have the same objectives and integrating our skills will lead to better experiences. The tasks and interventions may differ but goals are the same. So in short, more collaboration will create better outcomes for everyone.