‘State-funded navigators are needed to help older people choose the best care’

By Dr Chai Patel

The challenges facing the health and social care sector in the next decade are varied and complex. Integration is the answer to many of these problems, and would help us move towards a more effective and prosperous future.

I am passionately in favour of a system of mixed provision as the only means of delivering the best quality care to the largest number of people.

As the number of people requiring care increases exponentially – within 60 years approximately half of Britain’s population will be aged 65 or over – it is clear that pressures on the system will only continue to grow.

This staggering number shows that change in the sector needs to start now. This is the motivating force behind Demos’s Commission on Residential Care, of which I am a member.

Integration of our NHS and social care systems will provide the best and most cost-effective care for older people based on their individual specific needs.

Navigators

In my experience, the use of ‘navigators’ to help elderly people choose the care pathways best suited to their needs, and help them understand and access the right services available to them, is the best option.

‘Navigators’ would have a caseload of individuals whose needs they knew intimately, meaning they could guide them to the appropriate care provider.

The ability to organise and motivate different agencies on behalf of their client would be the primary skill required of a navigator. Ideally, technology, such as handheld devices, would help them access data quickly and make the system run smoothly.

Having these people in place with suitable technology would help save money that is wasted on patients seeing multiple providers unnecessarily, and would make the lives of older people much easier.

In terms of funding, navigators would be commissioned by the clinical commissioning group or local authorities and employed by either a public-sector or private-sector provider.

The availability of this service to all is critical to ensure the navigator has no built-in ethical or moral conflicts.

There is no longer an option of providing a ‘one-size-fits-all’ service. Physical ailments and, particularly, the increasing prevalence of diseases affecting cognitive function, mean personalised care is critical, and navigators would help streamline the system.

Better wages

Policy makers also need to focus on the staff providing care currently. There remains a stigma around caring for the elderly which needs to be addressed.

An increase in wages would be a good start and would help to improve the morale of staff and the quality of care in Britain. There is no doubt that care providers on the whole want to increase wages, but in the current system this is not possible.

To make it a reality, greater investment from local government would be needed and therefore more support from central government. If this were to happen, an increase in training would also be possible and staff turnover would decrease.

With continuity of care being so vital to those cared for and a direct link between staff turnover and quality of care, increased funding and training is critical to improving standards across the sector.

Increasing support from local and national government would also encourage further investment from private bodies. One of the greatest impediments to investment at the moment is the huge contraction in expenditure in social care.

If this was reversed the entire system would benefit, with savings made in high cost health areas, such as acute care, providing further funding opportunities for social care.

The investment community is interested in healthcare and sees it as an opportunity, but it also sees political hostility to private sector involvement in the UK.

This naturally leaves it with concerns and doubts about whether to invest. However, I believe that there is a genuine desire amongst the investment community for people who want to use their capital ‘with purpose’ to help address social concerns.

The creation of a clear strategy to ensure that social care has an equal standing to health, and for the funding to move between the two sectors, would increase confidence in the social care sector and, in turn, stimulate investment.

This would lead to better training for nurses, occupational therapists, and carers, better residential care home facilities, and a much needed supplement to public funding.

Greater provision of medical oversight in the community is crucial to taking the burden off tertiary (in-patient) care providers.

Less money wasted
Providing the best personalised care is not cheap, but investment from the government and private entities would not have to be as significant as one might at first think.

Firstly, a reduction in tertiary involvement in care provision, with more responsibility being held by GPs and carers, would be beneficial, both financially and operationally.

The fractured nature of primary and tertiary care means a huge amount of money is wasted in the current system, with patients unsure of who is fundamentally responsible for their care.

The use of ‘navigators’ would certainly help solve this problem and make integration a reality. With greater emphasis on community-based care, the government would save a great deal on acute care in particular.

Some of this money could be re-invested in the social care sector, improving its quality and efficiency, and take the pressure off private investment.

The services to provide care already exist, but in an inefficient system, particularly for older people.

The future of how we support those with long-term care needs will rely on greater integration of health and social care. An individual’s GP, navigator and carers should all be involved, with the active participation of the individual, in the decisions made about their wellbeing.

If this happens, both the quality of care and its ability to provide for all will be greatly increased.

Dr Chai Patel is chairman of HC-One and a member of Demos’s Commission on Residential Care.