Our new government now has to focus urgently on the health and social care problems of the UK. It must work out how the crisis in primary and community care can be turned around, and how the UK’s rapidly deteriorating indicators for investment, which has fallen substantially in real terms, treatment facilities and health outcomes, many of which compare unfavourably with other less prosperous OECD countries, can be improved. The NHS is looking distinctly threadbare.
Social care is a particular concern, sharing all the problems of recruitment, retention, morale and under-investment with the NHS. The rationale for reversing cuts to social care and investing more in these services is articulated in our first editorial by Lloyd D Hughes and Maggie Keeble. They point out how the recommendations of the House of Lords Economic Affairs Committee,1 which described social care funding as a national scandal, have yet to see the light of day, and reflect on the reciprocal relationship between levels of social care provision and pressure on hospital beds. Observational studies from high income countries show that better availability of long-term care beds is associated with shorter hospital stays and significant reductions in hospital costs.2
Less formal approaches to strengthening the fabric of community and social care have developed around the concept of ‘compassionate communities’ and the ability of well-organised community groups such as choirs and activity and interest groups to have an effect on reducing unplanned hospital admissions.3 Social prescribing in primary care is becoming increasingly widespread, although different models of engagement and navigation through the system are being applied.
In our Research section, Payne and colleagues’ study of a range of socially prescribed activities provides valuable data on how the potential of social prescribing to address multiple health and social problems can be realised. The authors describe a journey of engagement and participation, beginning with professional support and engaging with others through participation in social prescribing activities, learning different ways to relate to other people, developing new skills, changing and becoming open to new possibilities. The process leads to the development of a positive outlook on the present and the ability to move forward in pursuit of future goals and better health. The government is now in the process of formalising many of these ideas through the creation of an Academy of Social Prescribing, in recognition of the potential of these developments.
Technological innovation must also be encouraged. In their editorial, Ruth Chambers and Paul Beaney explore the potential of placing a digital assistant in patient homes, building on some of the positive findings in a pilot study in the north of England. Finucane and colleagues describe electronic care coordination systems for people with advanced progressive illness developed in Scotland, the use of which appears to have a number of benefits, including increasing the likelihood of terminal patients dying in their chosen location, in the community.
In an interesting report from Spain, Aznar-Tortonda and colleagues describe an Android app which provides a simple scoring system for the identification of frailty among older patients in primary care.
Let’s hope that the year ahead sees some really imaginative solutions to these difficulties, where the creative use of new technologies is aligned with a properly resourced health and social care system in which staff and patients are truly valued and we are, together, able to realise the immense potential of the NHS as a unique force for good.
A very Merry Christmas and a peaceful New Year to you all.
- © British Journal of General Practice 2020