Impacting home care: will political reform prove an enabler?
Even before the Health and Social Bill has completed its passage through Parliament, the effect upon the NHS has already been significant. Rapid reorganisation and the rationalisation of structures and staff have resulted in significant disruption to PCT and SHA work. Many staff have opted for voluntary redundancy or resigned in favour of posts in more stable organisations, leaving behind staff facing an uncertain future. Against this backdrop, opposition to the Bill appears almost futile as the realities on the ground mean few real alternatives to the reforms remain.
As the deadline for the end of both PCTs and SHAs draws ever-closer, Clinical Commissioning Groups in many areas are yet to organise themselves into meaningful bodies whilst uncertainties persist over the state of the health service that they are yet to inherit. Questions also remain over how, in practical terms, clinicians will achieve as much as their predecessors on only a third of the budget and fundamentally whether Clinical Commissioners will substantially differ in their decision making from PCT Commissioners. So what then are the implications of the new NHS on the Home Care industry?
Although various definitions exist, Home Care generally encompasses the delivery and administration of high value and complex therapies to patients in their own home as well as: home nursing; aseptic compounding; adherence support; clinical research; and even long term conditions management in the community.
Valued at over £1bn per year, the UK Home Care industry comprises several diverse providers of differing size and experience as well as many smaller NHS organisations and a handful of nursing agencies. The majority of the bigger providers are privately owned firms or subsidiary divisions of Pharma companies. Unlike these however, Bupa Home Healthcare stands alone as a Provident Association without shareholders.
Although wholly untried and untested, the latest reorganisation of the health service will, in theory at least, promote the increased use of Home Care as an alternative to more expensive hospital care. Successive governments have tried to promote the delivery of care in community settings as a means of reducing expenditure and numerous reports into the Homecare industry have demonstrated equivocal health outcomes to hospital care. However the unprecedented funding challenge the NHS must face, has for the first time created a burning platform for change which may make out of hospital care a widespread reality. Together with the levelling of competitive environment which has historically favoured the public sector, the Bill could allow the NHS to work more closely with Home Care companies in the provision of NHS services as it comes into effect.
The integration of healthcare – whether referring to primary and secondary care or the integration of health and social care, is another key feature of the discourse on NHS reforms at present. Even here however, Home Care companies have demonstrated their benefit to the NHS. Whether through Home nursing for patients with Continuing Care needs, End of Life Care or community care for long term conditions, many Home Care organisations are already proving that integration need not be as difficult to achieve as some NHS commissioners might think. In Somerset for example an innovative nurse-led COPD service, run by Bupa, supports both primary and secondary care in the optimal management of COPD patients, improving patient education and self-management, as well as preventing both admissions and readmissions to hospital. Accepting referrals from both GPs and hospital clinicians the service has demonstrated 10-20% reductions in unplanned admissions over the last few years. In Cornwall, our Home Nursing services provide a combination of domiciliary and nursing support to complex patients who would otherwise require hospital admission at significant increased cost, saving the PCT £1.8m a year.
Of course, not all patients can or should be treated at home and few believe that Home Care could ever replace hospital care entirely, but delivering improvements in Ambulatory Care Sensitive Conditions, promoting early discharge from hospital and preventing admissions through the use of telehealth technologies are all significant enablers. If fully realised, Home Care could significantly modify the trajectory of healthcare spending over the next ten years. As long as regulation exists to safeguard the quality of care provided, patients, the NHS and Home Care companies will all be able to benefit.
Although the challenges which lie ahead are significant, we believe they are not insurmountable. Home Care is certainly well placed to take on much of the burden of hospital activity which drives unnecessary expenditure in the NHS and in providing increased nursing capacity to the NHS and integrating across traditional boundaries of care, Home Care companies can certainly provide a much needed perspective on tackling the looming Nicholson challenge.