Central to the future of social care in the UK is the integrated care model that requires the NHS and social care to work together to provide a single package of integrated health and social care to people who need it.
I recently read an article in the Financial Times that gives an insight on the success of the integrated model of care in Japan which the UK may take cognisance of in the future development of the integrated health and social care model.
Four years ago, health officials in Komagane in central Japan were wrestling with a persistent problem. As in the rest of the country, the ski-resort city has a large elderly population — nearly a third of its 32,000 residents — for whom strokes are a significant health risk. Yet, in Komagane, the stroke mortality rate, particularly among women, was far above the national average. The officials knew that stroke patients are at risk from a recurrence, with potentially deadly or debilitating consequences, and that lifestyle changes can cut that risk. But how to make that happen?
Preventive care and self-management support
To address the problem, they embarked on a joint project with Komagane’s main hospital to provide preventive care and self-management support. That scheme succeeded so well that Japan is now promoting it as a model for integrated healthcare across Asia. It also offers pointers for countries such as the UK, where the coronavirus pandemic has highlighted a need for deeper collaboration between different parts of the health and care system.
Japan, which has the highest proportion of elderly people in the world, has spent much of the past two decades trying to connect hospital treatment with broader prevention efforts and nursing care services. In 2000, it introduced the Long-Term Care Insurance System, which is designed to finance long-term care for people over 65 — some 29 per cent of the population.
Integration of social and medical care
Unlike the welfare schemes it replaced, it seeks to prioritise user choice and to integrate social and medical care. The number of people receiving benefits such as home visits and nursing care services has more than tripled since its introduction, to 6.7m. Building on this system, the country began, from 2006, to adopt the so-called Community-based Integrated Care System. Under this initiative, municipalities will aim to co-ordinate public and private health services for old people by 2025, when the first cohorts of Japan’s baby boomers will have turned 75 or older. The aim is to enable the elderly to continue living in their communities while receiving long-term care.
Patients compile own support plan
Under the joint programme devised by officials and doctors, stroke patients now compile plans to manage their health with support from nurses and nutritionists. After discharge, they are given pedometers to keep track of how much they are walking, and are asked to record their dietary habits and daily blood pressure in a notebook. Using this data, hospital staff follow up with patients for 12 months after discharge to ensure that they are sticking to their plans.
To make co-ordination easier, Komagane officials set up an office inside the hospital, allowing them to connect directly with elderly people requiring long-term care. Their efforts have paid off. Hospital data shows that the recurrence rate of strokes among patients within a year of discharge fell from 10 per cent in 2017 to 3 per cent in 2020.
Disparities between communities
Some critics point out that there are big disparities between communities that have been able to provide integrated services and others that have lacked the human and financial resources to do so. Takako Tsutsui, an expert on care management for the elderly at the University of Hyogo, says such gaps were exposed during the pandemic as hospitals were forced to co-ordinate with nursing homes to take care of elderly COVID-19 patients. “The collaboration between hospitals and nursing care homes deepened for those communities where managed care was functioning,” Tsutsui says. “But not for those who had no prior history of working together.”
As health and social care services in the UK are about to embark on a model of integrated health and social care it seems prudent to see what is happening in the rest of the world in respect to the integrated care approach. Japan has adopted a model of integrated care and there is evidence that it has been successful with stroke patients and services for older people which may be adopted as part of an integrated care service in the UK.
A note of caution, however. Critics say there is a disparity between the success of the integrated health and social care model where human and financial resources were available and where they were not. As Japan has found, if the integrated care model is to work in the UK it must be given the human and financial resources to manage it.
Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy