If you look at the 2020 vision statement, which is about people being cared for at home or in a homely setting, you will see that, fundamentally, the funding is going in one direction and the policy is going in another direction. That is why we have gone down the road of integrating health and social care.
10:30
As I said earlier, there are things that we can drive out of the system. There are barriers and things that go on that should not go on in an integrated health and care system. We will resolve some of those issues and will stop people being caught in the referral pathways, as happens just now. However, because of the demand at the front door in acute services, the investment in many boards is going into the creation of extra resources in acute services. I think that Professor Mercer’s point is that we must redraw the line and say that we need to manage more of that demand in the community. Part of the objective of the reshaping care for older people policy was about managing that demand and developing services in the community.
Do not get me wrong; I am not saying that nothing good has been done on that. A lot of really good work has been done on dementia care in particular and on developing some of the specialist home care, and a lot of good work has been done in the third sector. However, it has not shifted the main stream. Reshaping care for older people got about 1 per cent of investment, and we need to shift the 99 per cent that is currently invested in health and social work. That is what we are grappling with at the moment—that is what we need to do.
We are consulting just now on our future model. My view is that we all need to begin the shift to building the model around primary care, particularly general practice, which some areas have done. There is a fundamental question about how we begin to do more of the preventative work in the community that prevents people from turning up at A and E while we still have to build new assessment units in hospitals. In Ayrshire, we are building an assessment unit in front of the hospital—we call it building for better care—so that we can manage some of the A and E demand. We need to try to manage that demand but, at the same time, if we are not investing enough in community care and primary care, particularly general practice—I agree absolutely on that—we will not be able to shift the demand. That is what we need to attempt to do next.
We are thinking about how we can free some resource to begin to make that investment in the long term. The Government has announced the integrated care fund, and North Ayrshire will get £2.9 million. Our total budget is £200 million. We are focused on deciding how we can use that to make the change and free up some resource. However, that will not shift the main stream. Most of the money is invested in the hospitals. The big question for us is how we begin to reduce the use of hospital care and increase the services that we offer in the community—better and more joined-up services—that prevent people from turning up at A and E and being admitted because, as Joe McElholm says, we do not know what to do with them.
Once an older person—not just an older person, but anybody with multiple morbidity; in fact, any of us—is admitted, their confidence is impacted and it is more difficult for them to return home. We still have a mindset about sending such people to care homes because it moves them on. We need to tackle that and we will begin to do so, but we need to do it in conjunction with colleagues in acute and secondary care, because it has to be done on a system-wide basis.
The short answer is that we have some short-term money that will begin to help us if we focus it—we will focus it this time, as we have learned from reshaping care for older people—on the change that we need to make in the partnership. However, in the longer term, we need to find ways to reduce what we spend on in-patient care and move it over to the community. That will not be easy.