Developing preventative strategies and avoiding crisis interventions
Community health and social care support should not be seen as a service of crisis intervention but as one to help and support people at the earliest stage, preventing deterioration and people getting into crisis situations. There are opportunities through the creation of the NCS to enhance our focus on the health and wellbeing of our whole population, with a positive impact on life expectancy and on quality of life. To achieve this, our health and social care systems must work together to support everyone to live as independently as possible, whatever their needs and no matter where they live. This will require different behaviours and culture, working practices and delivery models across the whole system of care and support, building on the success of self-directed support options which empower individuals to plan for their own care needs.
People should be supported in their homes, within their communities and among their family and friends. This support should enable people to achieve the things that are important to them, with input and direction over the support they receive.
People, those with care needs and unpaid carers, must be central to the decision making around their community health and social care support. They must be able to say what matters most to them and have this acted on. These wishes should be recorded and shared with relevant health and social care professionals to support this. Where people rights and liberties are restricted due to incapacity or justice, their rights must be maintained as far as is possible. This will enable people to receive their care, treatment and support according to their needs and preferences. It will ensure that everyone involved can act together to support shared outcomes.
Self-directed support options empower individuals to plan for their own care needs. It will be easier for people to ask for support by having a direct route to access support and making sure they only have to tell their story once. We will improve the process for considering people's needs and deciding what support is needed, putting people at the heart of decisions about their care and building on their strengths. We will transform the delivery of social care support, moving away from a focus on risk and instead enabling people to access the social care support they need in their communities to live a full life. This approach will contribute to realistic medicine, where people are given consistent information to enable then to be a full partner in their support and care plans. The planning and provision of community healthcare will be an important aspect of this process.
The development of a National Care Record will enhance these ambitions. It will ensure that people's necessary data and information moves with them across sectors, in line with data protection laws, from prevention and early intervention to acute and specialist provision.
Prevention, early intervention and rehabilitation when issues first emerge are critical in delivering improved outcomes for people. It requires truly integrated health and care support at an individual level. When successful, this focus on early investment avoids the need for more costly action at a later stage. For example, social care occupational therapists have specialist expertise which is invaluable in contributing to finding the best solutions to support people in their own homes. Timely installation of an adaptation or a piece of equipment prevents or delays the development of more acute health and social care needs.
The social care, social work and community healthcare systems currently are often driven by acute and crisis support rather than prevention and early intervention. The focus must be to change the way community health, social care support and social work services are designed and cooperate with each other. Prevention, early intervention and rehabilitation must be prioritised. People will move seamlessly between different types of care and support as their needs change.
The third sector plays a multi-faceted role in community health and social care and must continue to do so for these reforms to succeed. The pandemic showed that community groups and third sector organisations of all sizes are central to ensuring that people who need care have the assistance with day to day living they need. That care and support very often goes beyond regulated care provision to ensure a better quality of life-based on wellbeing and human rights. As well as extensive experience in quality regulated care provision, the third sector provides a comprehensive range of wellbeing services. These include befriending, community activities, community transport, networks of lived experience or home from hospital services.
Improving social care support, particularly increasing early intervention and prevention and supporting unpaid carers, including young carers to protect their health and wellbeing, reduces costs which would otherwise fall on other parts of the public sector. This may include unplanned hospital admissions, additional residential care needs, family breakdowns and more. It is difficult to fully estimate the size of these efficiencies and benefits, but they are expected to be considerable.
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