The Future of Care
Our vision for the future of care
eLearning For You is proud of its long-standing heritage in care. Dating back to the 1800s, our lineage includes The Royal Buckinghamshire Hospital (RBH), and it’s conception by Florence Nightingale.
Our group’s commitment to care reaches beyond eLearning, our services providing rehabilitation for complex needs, domiciliary care, care training and promoting a life beyond disabilities. As such, as have some incredibly talented staff in the group, including Boda Gallon who is MD of the Affinity Care Group, our specialist care division. In April, we sat with Boda to discuss our group’s vision for the future of care.
Providing better outcomes
A big issue that we have faced at The Royal Buckinghamshire Hospital is the ability to provide better outcomes for our patients long term, beyond rehabilitation. How do we get them from hospital to home, and how do we stop ourselves from blocking that path? We’ve recognised that there isn’t just one service or one provider who can do everything – but there is a need to provide a genuine pathway of services from hospital to home, which can only be achieved through collaboration. Part of that collaboration is working with the NHS, the third sector, other private providers, statutory services and importantly, with housing associations. In the long term, there are real world problems that face our patients after a physical rehabilitation, that are beyond physical needs – how do you manage the rest of your life, and how can we support your family? It’s important for us to collaborate with a range of providers from education to housing, and social enterprise. It’s about accepting that we are only one component, but in doing so, providing a much wider context of rehab.
Complimenting the NHS
The NHS is under such pressure now that it’s starting to recognise the need to collaborate. The three things that the NHS struggles with are:
- Capability – the NHS recognises now that it doesn’t necessarily have the lateral capability to do everything itself, or the experience to be able to design and deliver integrated pathways all the way through to the community.
- Capacity – the system is in real trouble, you hear it almost every day. Patients are backed up in A&E because the NHS can’t get enough people through the system. They often have very low tariff people blocking very high tariff beds, therefore it’s not efficient in terms of their income generation or positive patient outcomes and experience.
- Capital – the NHS has limited funding, but the independent sector can access it. So, the key thing here to help provide the best opportunities for patients and unblock the barriers is to say, “look, you’ve got patients, you can give us patient flow, working together we can raise capital. We’ve got the capability and we can then deliver increased capacity”. Ultimately, this will help pull people through the system.
Keeping people out of hospital is the key, not just discharging them, but ensuring that when they are discharged it is sustainable, and there isn’t the current cycle of re-admission after re-admission, because there is this big gap between home and hospital.
Role blending and integration
Until recently, many independent rehabilitation service providers deliver 5-day week rehab services. But, rehabilitation doesn’t and shouldn’t end at weekends – we need to provide 7-day working weeks for those in rehabilitation. This can be a challenge, particularly culturally, to shift this mindset among staff. But, 7-day working weeks for doesn’t mean doing the same thing everyday and must include social opportunities too.
We have to be more patient-centered and to support this, part of the role blending exercise should be to understand that we need to up-skill our support staff and our nurses. The therapy element of rehab doesn’t just go on within a therapy department, we need to look at integrating and involving the multidisciplinary team better, including our consultants.
Funding and ACOs
The biggest challenge for us isn’t necessarily the sometimes-glacial speed that the NHS works at, it’s more to do with the barriers that exist around funding – it’s the flow of money that gets in the way. There’s very few people who disagree that an integrated model of rehabilitation makes sense, its common sense, no matter how much you fight it. So, ultimately the major barrier which has caused people to be less innovative and less creative, in terms of trying to provide a range of services along a service pathway, is often budgets which particularly in rehab are held in maybe 4 or 5 different sources. From NHS England, who have a responsibility for specialist rehabilitation, and then the CCGs, and then within the CCGs there are different pots of funding, this whole system is very fragmented and disjointed.
Another issue at present is the funding for social care and housing. Ultimately, our patients are facing the problem that at each stage, each of the current fund holders are likely to do nothing other than maximise the benefit of their individual ‘pot’ for 12 months, and the benefit of rehabilitation unfortunately is by investing to save over a longer period of time. Sometimes, at the high end, people won’t necessarily make that investment because they don’t see the long term saving returns themselves, even though it saves money for others further down the line. For insurance funded clients, defence lawyers have the luxury of looking at a whole life cost, and they can look to invest in either equipment and/or early rehabilitation to reduce the dependency of the people, even if they require long term care. This tends to provide a much better outcome for the patients because they are more independent, but it also reduces their long term liability. Taking that model of funding is really what is essential for rehabilitation, and to help people move through a system that we can coordinate and look beyond the 12 month pattern of investment.
The development of ACOs (Accountable Care Organisations) and the full reversing around to a single integrated funding pot will hopefully make a massive difference, and it will go back to that purpose. Ultimately, mirroring where we see the best patient and financial outcomes and the benefit for this service for our medical legal funded or insurance funded patients.
As of now, the biggest focus for the future is pulling a range of facilities and services together. The buildings nor the service partnerships are the tricky bit, as they can be pulled together and coordinated. The big challenge for the sector is about breaking down that fragmented pathway from hospital to home, more than anything, in terms of the funding and incentivising all involved to collaborate and invest in long term savings. The key thing is if you can get it to a process where there’s a single pot of money following the patient, it provides better outcomes for not just the patient themselves, but also financially.
The ultimate aim is to try and help people become as physically, emotionally, educationally and vocationally independent as possible, in every aspect of their life. Some of those aspects are more than physical and emotional, like here at RBH, we focus on clinical outputs but also the well-being of the patient. These things are not complicated, it’s about linking and trusting in people and developing a network of like-minded partners. Rather, it’s about being flexible enough to see that rehabilitation is about the quality of life for every patient in every single aspect.