New and Improved Health and Social Care 2013-2018

                By Changing Nothing, Nothing Changes. 

As Health and Social Care professionals we are all aware that change is just a part of everyday life. We are constantly being told of new reform and strategy changes that “will happen soon”, but are we always aware when this actually happens? With heavy work schedules, large case loads and busy family and social lives to also think about, I am well aware that it is very difficult to keep up with all the new changes that affect us within Social Services. I hope to provide a brief summary on the relevant new changes happening now.

The personal independent payments [PIP’s], for example, started to replace the disability living allowance on 8th April 2013. There is a phased rollout, with majority of claimants transferred between 2015 and 2018. From June 10th all new claimants will go on PIP [Occupational Therapy News: June 2013.

 The Disabilities Facilities Grant [DFG] is another area in which some major changes are happening throughout the UK. The proposal to raise the grant limit from £25,000 to £30,000 has been implemented as of April 2013, with a view to increasing this to £50,000 in the near future for major and multiple adaptations [http://www.careandrepair-england.org]. Other changes include the clarification that access to the garden is covered  by DFG legislation, that stair lifts could be ordered through the Community Equipment Service [this takes into consideration that specifically designed stair lifts have little potential to be reused], and the promotion of new methods for procurement of adaptations and equipment to reduce costs.

A Council in London has implemented this change by providing major adaptations, up to £4,000, to over 100 people through direct payments [Occupational Therapy News; March 2013]. Sixty out of the 100 people used this money to install a Level Access Shower. This has proved to be a quicker, more effective alternative to waiting for a DFG, although DFG’s are still available. This also provides clients with greater choice and control as a result of using direct payment. OT News [March 2013] also reported that this was a much more effective preventative measure allowing people to access adaptation at an early stage to reduce or prevent the need for social care later on down the line; for example reducing risk of falls, thus increasing quality of life and reducing cost to services.

The reform of England’s NHS commissioning structures has been discussed in length for the past 3 years. It hardly seems real that as of April 1st 2013 we are now seeing clinical commissioning groups [CCG’s] and the NHS Commissioning board finally taking power. We say goodbye to the old Primary Care Trusts and hello to the new CCG’s.

CCG’s are now at the heart of the new system for all health and social care professionals. The GP – led bodies are responsible for 80% of the NHS Commissioning budget-  so it’s probably a good idea to know your local CCG as they will commission most services – Link to directory https://bit.ly/Z6B60v

With new pressures on us all to maintain and increase service user independence and safety in their own homes there may be further increase in OT referrals to help reduce the cost to primary and secondary services. Although this may appear daunting at first, I personally am delighted that we all now need to work together more closely in the best interest of the client. I, as I’m sure many of you, have also had bad experiences with clients being discharged from Hospital unsafely causing high urgent OT referrals and high risk of readmission.  An example of this was Mrs P. who was admitted to hospital with a Right fractured shoulder.  She also had fibromyalgia and arthritis in her knees and hips. Prior to discharge Mrs. P had no OT intervention in the hospital and was not asked anything in relation to her home situation other than if she lived with anyone, to which she answered “My husband”.  Three Hours following discharge Mrs. P’s husband contacted social service to complete an Urgent referral. On assessment it was documented that Mrs. P’s Bedroom, bathroom and toilet were all upstairs and Mrs P. had two mopstick banister rails in situ. It was also reported that even prior to admission Mrs P. needed both hands to use the rails to access her upstairs facilities. On discharge Mrs P. was unable to access upstairs facilities and was left to use a “bucket” to go to the toilet until an urgent OT visit was completed to provide a Commode. Following full assessment Mrs. P was in fact in need of a stair lift.

With such demands to reduce high volume of inpatient admissions it is also important that we take responsibility a long with the consultants to educate and inform them on how best to manage not only their conditions but the social and environmental situations also and to ensure that all clients, particularly those over the age of 65, are seen by a hospital OT prior to discharge.

The deputy Prime Minister Nick Clegg was quoted at a question and answer session at Berwick Northumberland on 25 January 2013 “There is a clear need to shift care further into the community and focus services around client’ needs and desired outcomes” “Occupational Therapists are among those best placed to understand the needs of service users and deliver personalised care through joint working with the commissioning GP’s”.  This is incredibly true and now with the CCG’s in full swing it is important we take responsibility and control on how best to educate GP’s and other health care professionals on how we can help in the long term cost savings within health and social care.

Who knows maybe if GP’s realise the demand and need for such community services it can be looked at future cost savings by restructuring cost of services and increasing the pot of money for more OT’s in the community. We can all hope.

This is to be just a brief documentation of some of the changes that affect us. Please feel free to email me on karacronin@live.co.uk should you require any further information.

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