Aging population has many interpretations, some of them very positive such as the fact that more and more people are fortunate that they live for longer with a fairly healthy life. The other side of the coin is that there are also problems such as increased multiple combined chronic diseases, social deprivation and the fact that many people reach an advanced stage of geriatric frailty. And this is where service delivery models that have been consolidated in recent decades are still struggling to give satisfactory answers. Governments know it and, for this reason, are launching initiatives to address chronic disease and frailty in a more effective manner but these programs often face political difficulties, resistance to change and difficult to overcome bureaucracies.
From everything I've seen in this issue, I think the British are the most daring, so I chose the report of the "Commission on the future of health and social care in England" published by King's Fund, because it synthesizes very well what the problems of current models are and what are the solutions to be put on the table.
First problem: the current model is unfair. The health system is universal and free, while access to social services is restricted. Let's say two examples: people affected by cancer enjoy global coverage, regardless of process costs and economic level of the patient, while Alzheimer's patients suffer from limited access to services, especially in more advanced stages when their needs are more social than medical.
Second problem: funding sources are different. The health system feeds directly from the public budget, while social funding source is hybrid, with participation of different administrations, including the local, and with a variety of complex management copayments.
Third problem: social and health systems are not coordinated. Models of provision of health and social services have, by themselves, internal coordination problems, but when patients appear with social and health needs combined, then it’s evident that services are more focused on how to organize the criteria of the offer than in how to solve the real problems of each person.
Three British proposals that should be the focus of all integration initiatives between health and social services
First proposal: joint purchase of social and health services based on defined processes.
Second proposal: development of individualized therapeutic plans jointly between social services, primary health care and hospital care involved.
Third proposal: developing scales of needs and lifting the limits of access to social services of the most complex patients.
The integration of social and health services is a challenge that must be tackled from above (alliances and mergers), but also from the professional level (through multidisciplinary work), with the aim of assisting the complex patients in a more coordinated and consistent manner than today.