Why COVID-19 allowed us to believe in a different future for health and social care

Anna Chainey is a trainee on the Health Education England Consultant Practitioner Development Programme, Older People and Frailty pathway. For the peak COVID-19 pandemic period of Mid-March – July 2020, Anna paused her training and was redeployed into the role of Lead Coordinator for discharges for Dorset Healthcare University Foundation Trust, working within Dorset County Hospital.

The COVID-19 pandemic has been the worst period that many people have lived through. However, for health and social care, it has also led to some of the greatest innovation and transformation, demonstrating how partnership working across traditional systems and boundaries can truly be achieved when everything is being routed through one funding source.

Social care and the NHS are becoming increasingly interdependent. People who receive good social care are, after all, much less likely to require NHS treatment and services. Up to 58% of people over the age of 60 already have one long term condition and more than 5.4million relatives and friends provide crucial unpaid social care to those in need. However, funding to the social care sector fell by 11% between 2009/10 and 2015/16. In response to the COVID-19 pandemic, health and social care services responded more quickly than we would ever have believed possible, working collaboratively in many parts of the country to support new initiatives and alternative ways of working to meet the needs of the population safely.

At the peak of COVID-19, the Government issued the Coronavirus (COVID-19) Hospital Discharge Requirements that outlined the expectation for all NHS Trusts to rapidly create Discharge to Assess models to support people being transferred out of hospital. This model used a single source of funding, that worked across systems and relied upon true interprofessional cooperation. This helped to break down the traditional boundaries that existed previously due to funding streams and ensured that no unnecessary assessment was undertaken in the acute hospital. The Discharge to Assess model split patients into 4 discharge pathways:

• Pathway 0 – home with no increased care or support
• Pathway 1 – home with a new or increased package of care
• Pathway 2 – discharged to a bedded unit (Community Hospital or interim placement) for further rehabilitation
• Pathway 3 – people with very complex health needs who had had a life-changing event and were unable to return home, or people who required a placement for end-of-life care

Once people were deemed ‘no longer needing to reside’ (previously known as ‘medically fit’), the multidisciplinary team that included nurses, therapists and social care colleagues, all overseen by a Lead Coordinator for discharges, were responsible for organising discharge of all patients on pathway 1-3, within three hours. Due to COVID-19 funding, there was no discussion regarding who was eligible for funded care or who was responsible for funding the care. Patients were therefore able to leave the hospital with the care that they required in a very timely way. Care was provided by contracted short term bridging options, NHS rehabilitation teams and private care agencies with health and social care colleagues supporting people discharged home through a process of case management. This included following them up at home to undertake assessments and funding conversations that would have traditionally have taken place in the hospital.

The Discharge to Assess model shows what can be done when health and social care truly work together without the constraints of separate funding streams. Undoubtedly, the single funding source used for COVID-19 will not last forever. But the Discharge to Assess model is here to stay. The pandemic has allowed us to believe that new ways of working are truly realistic and possible. We can finally dream of a future where health and social care are not thought of separately by the Government but as one team, much like its workforce already choose to work!

It is clear that further consideration needs to be taken when designing health and social care services of the future, viewing them as a whole and not as two separate entities when planning deployment of the workforce, and sourcing short and long-term care funding. It is not known what post-COVID-19 health and social care will look like at this point. What is clear is that going back to ‘business as usual’ is not likely to be the solution.

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