What the health and social care transformation means in practice

There is often a tendency when new governments come into office, to sweep away work done in the past and go over old ground again, thinking they will be able to come up with something no one has ever thought of before.

Something to make their mark when there are no new buildings to open.

The result is that little progress is ever made, or if it is, it happens at glacial speed.

Having an open mind, sometimes rare in politics, can pay dividends and nowhere is that more true than with respect to the transformation of health and social care.

I say all that as we really don't need to re-invent the wheel here.

Back in 2011 the States approved what was called the 2020 Vision.

I can hear the groans now – not a Vision! Please bear with me.

As I said in my previous article, our system of health and social care is unique and complex.

It would be no good, I would say catastrophic, if we approached transformation in any way other than strategically, with defined goals in mind.

It is the lack of strategic thinking that has resulted in what we have today.

Politicians have tended to be sucked into day to day operational issues and immediate crises, so easily done it has to be said, with the consequence that little progress is made in addressing the underlying structural issues.

There is often an overriding desire to be seen to be acting immediately to a particular event, when what is needed is cool reflection and a consideration of the bigger picture.

That doesn't mean ignoring what's happening, but rather not to take knee-jerk reactions which often prove more costly and lead to other problems down the line.

Things happen.

They inevitably happen in Health and Social Care, a complex organisation that involves thousands of individuals caring for thousands more.

As a Government, our aim is to minimise the risk of things going wrong, but we can never eliminate it.

What is crucial is we don't seek to blame, but develop a culture of learning and continuous improvement.

This is essential if transformation is to have any hope of success and is something I will address in my next article.

So, back to the 2020 Vision, a document that has, more or less, been gathering dust over the last 6 years as HSSD lurched from crisis to crisis.

It is a common sense statement of goals which go to the heart of what the transformation of health and social care is all about.

It's not the easiest document in the world to read, although this is not a fault of the authors, more the fact that government tends to forget the importance of plain English in the democratic process.

Is it any wonder people don't engage with Government when they hear phrases like 'core deliverables' or 'strategic alignments'?

Putting the style of the report aside, there are key principles in the 2020 Vision which are central to transformation and that are worth highlighting, namely: patient centred care; moving care away from the hospital and into the community; partnership & engagement; treating mental health with equal consideration as physical health; better use of technology; and, probably the most fundamental principle of all, prevention and early intervention.

Patient centred care

There are probably quite a few of you who, when brushing up against the health and social care system, know the frustration when you, or someone you care for, has to recount their story to more than one person.

Not only is it irritating, but it isn't efficient either.

It's a reflection of how the system has evolved with services being added to over time.

We need a more joined up, patient-centred approach to care.

To ensure better outcomes the various parts of the system need to work together more closely and 'wrap' around the patient.

That means providers of primary care (such as GPs) and secondary care (hospital and specialists), mental health and physical health, as well as health and social care, providing a joined-up service.

Moving care away from the hospital into the community

There is a general obsession in the media about hospital beds.

I've constantly been surprised how the closure of beds, or a ward, can cause such debate.

Fifty years ago hospitals were full of dormitory sized rooms full of beds.

People would go in there for a broken arm and stay for weeks.

Today we know that you should only stay in hospital when you really need to and for no longer.

For our more elderly citizens this is particularly important.

The longer the stay in hospital, the more likely that your bodily strength is reduced and dependence is increased.

The number of procedures that can be done without requiring an overnight stay are growing by the year.

At the same time, new ways of working are shortening stays in hospital.

We need to take advantage of these trends, whilst at the same time investing in community care, to help people live an independent life for as long as possible.

This is good for the patient and good for the government's finances.

Hospitals are very expensive to run and keeping beds open that are not needed is money down the drain that could be invested in the community.

Of course, it is easier said than done, but the assumption that there should be lots of beds kept open 'just in case' is not the best use of money or resources.

Treating mental health with equal consideration as physical health

Recent years have seen a sea change in the understanding of the importance of good mental health and wellbeing.

The mind is as important as the body, our mental health can affect our physical health and vice versa.

It is estimated that half of us will experience poor mental health at some time in our lives.

Not only is that bad for the individual, family and friends, but also the economy, with stress-related illnesses being a leading cause of days off sick.

We need to ensure our mental health services are not a last resort, but an integral part of the wider picture of care for everyone and that employers and the wider community are part of the solution to better mental health.

If we are to have any hope of being one of the happiest and healthiest communities in the world, we need to make this happen.

That is why the Committee for Health and Social Care made it an explicit commitment in the Policy and Resources Plan.

Better use of technology

Taking a tour around our Bailiwick hospitals, you might think that we make considerable use of technology already and you'd be right.

Our radiology rooms and pathology lab are testimony to the massive investment made to provide the scans and tests we now all expect.

Multiple software applications are also used throughout the health and social care service by government and partner organisations.

However, we really have not brushed the surface when it comes to the use of digital technology that will help people to be cared for and supported at home, and assist those working in the hospital and wider community.

Paper is still alive and well, resulting in inefficiency and greater risk of avoidable error.

In many cases the relative costs of such technology are not high and are certainly outweighed by the benefits that they will unlock.

At the same time such data needs to be joined up.

We will only truly unlock the massive benefits of technology through the Holy Grail of a single patient record.

Partnership and engagement

When the subject of health and social care comes up, which it tends to do in some form or another on a daily basis, most people will immediately think about the care provided by the States of Guernsey.

It's probably true to say that, in the past, the States of Guernsey has thought that too. However, there are many organisations, apart from Government, providing health and social care support in the Bailiwick.

Such provision has been invaluable, but not necessarily co-ordinated.

This has resulted in duplication of work in some areas and gaps in others.

Part of Government's role should be as a commissioner and coordinator, to enable people to have the right care, when they need it, where they need it, by those best qualified to deliver it.

That means we need to work far more closely with our partners. At the same time, we need third sector organisations to work more closely together too.

The Guernsey Disability Alliance and the recently established Dementia Friendly Guernsey are examples of where this has begun to happen.

But partnership is not just about how providers work together, it's also about the engagement of the patient, or dare I say 'customer'.

This isn't a word that sits comfortably for some in health and social care, but that's exactly what we are when we receive services from health and social care providers.

The important thing to understand is that to achieve the best health outcomes, we all need to work with each other, whether we are the provider, or the one benefiting from that provision and Government needs to help make that happen.

How can we be helped to help ourselves?

Prevention and early intervention

The only way we will fundamentally improve health outcomes and create a sustainable health and social care service is through a concentrated focus on, and investment in, prevention and early intervention.

Stop people getting ill in the first place and, if they do, treat them before it gets worse. It all makes so much sense.

So why don't we do more?

Well, I hate to say this as a politician, but our parliamentary system plays a big part.

Deputies are voted in for a 4 year term, not 10 or 20.

Whilst that is good for democracy, there can be a tendency for politicians to think in the short term and seek immediate results to please their electorate.

At the same time, the requirement to meet short term fiscal targets can hamper medium to long term strategic change.

That's a problem when it comes to investment in prevention, the benefits of which can take years, or decades, to become apparent.

Tobacco is a case in point.

The number of people smoking has reduced substantially in the last 10 years, but the full benefits of this reduction, in terms of the treatment of preventable diseases, such as lung cancer and cardio-vascular disease, whilst reducing, are still higher than would be the case were the current rates of smoking in place 50 years ago.

Work in the social care setting, to help all children get the best start in life, whatever their background, can take a generation to bear fruit.

A focus on medium to long term goals really is the only way to have a chance of maintaining the quality of our services, without putting a growing strain on public finances.

However, those are not solely the responsibility of the Committee for Health and Social Care.

Public health messaging about how bad it is being overweight, drinking and smoking really is not enough.

I would suggest that there are many people know that they have an adverse effect on their health, yet at the same time do nothing about it.

There are more fundamental issues that need to be addressed here.

That there is a strong connection between health and wealth is now well understood.

Research by Sir Michael Marmot for the World Health Organisation, and others, have demonstrated that the poorer you are, the more likely you are to have poorer health and have a lower life expectancy.

It is a graduating scale.

The States recently released the results of a survey which showed 22% of people live in relative poverty, calculated as income 60% below the median.

Of course that doesn't mean anything in and of itself, but what does, is to what extent that impacts on health, living longer in good health and life expectancy.

Whilst Guernsey does not experience the levels of deprivation seen in certain parts of the UK, we need to understand how our current system of health and social care has an impact here.

For example, to what extent does the fact that people have to pay to see their GP create health inequalities?

It is easy just to look at the health and social care system to explain health inequalities.

But, as Marmot made clear in his review, the circumstances in which people are born, grow, live, work and age all influence health. These are the social determinants of health.

As such, it is not just the Committee for Health and Social Care that is responsible for the health of Islanders, but the whole of Government through the policies it drives forward and the priorities it sets.

More on that, and how we are approaching the transformation of health and social care, in my final article.