This strategy will determine the allocation of£269m for the NHS in England announced by the prime minister last week. It is part of the government's long-term strategy to modernise the health service and knock down the `Berlin Wall' that separates health and social services.
As the Audit Commission publish a report - `The Coming of Age' - on care for elderly people, Frank Dobson says in a letter today to chairmen of health authorities, trusts and social services that he wants to:
-- focus the£269m of new money for the NHS in England on modern care services for elderly people
-- foster cooperation between health and social services
Frank Dobson said:
'The extra money announced by the prime minister last week is not just to help this winter. It is also intended to start modernising the NHS for the long term, pioneering new approaches which will bring lasting benefits. It will help to break down the `Berlin Wall' that separates health and social services, divides care and stifles the development of better support for the frail and vulnerable.
'Elderly people are not getting the service they deserve. Some are sent home from hospital before they are ready, while others are kept in for too long. That's bad for them and for the people waiting for a bed.
'Today's initiative is a key part of our proposals to help the vulnerable people who depend on the NHS and social services and I expect it to be given a high priority.'
In his letter, which will be followed by a circular on better care for the elderly and a circular on the allocation of the extra money to health and social services, Mr Dobson explains that the new money will be targeted on getting health and social services to work together and on schemes which will have the greatest impact.
His priority areas are:
-- increasing staffing levels at times of peak pressure and extra opening hours to cope with medical emergencies during the winter months
-- more rehabilitation and recuperation services, home care, and extra places in care homes, to reduce delays in discharging patients from hospital
-- more specialist nursing and therapy - particularly for older people - in their own homes and in care homes to reduce the need for people to be admitted to hospital in the first place
Mr Dobson says in his letter:
'I am determined that health authorities and social services departments should work together to tackle local problems and use the
money where it can have best effect.
'I am also determined that this money will be used not only to improve the efficiency and effectiveness of services this winter but to contribute to the building of better health services in the medium term. These resources, building on the work that you have already
started, offer the opportunity to improve services, relationships and systemsin a way that will have longer-term benefits and provide a platform for real improvements in the future.
'I know that your prime focus in the coming months will be on managing the immediate pressures but I am keen that we establish this development agenda now to help us manage better in the longer term.'
Health minister Paul Boateng said in response to `The Coming of Age' report:
'I welcome the Audit Commission's report. It fully supports the strategy we are outlining today. Both we and the Audit Commission agree that we are determined to deliver a better deal for patients and the measures we have announced today are the first step in a new strategy to improve care for elderly people.'
A department of health circular issued on better care for elderly people to health and social services emphasises three priorities:
-- Effective Joint Investment Plans for services to meet the continuing and community care needs of local populations
-- Improved multidisciplinary assessments of older people in both hospital and community health care settings
-- Development of recuperation and rehabilitation services for older people by health and social services
Mr Dobson says he wants to see progress building on current good practice in three areas to improve equity and quality of care, move to closer to his goal of social inclusion and promote greater independence for older people.
1. A copy of Frank Dobson's letter is attached. Last week he announced there would be an extra£300m for the NHS in the United Kingdom -£269m for England.
2. NHS chief executive, Alan Langlands, and chief inspector of the Social Services Inspectorate, Herbert Laming, are writing to chief executives and directors of social services setting out the detail and timescales of today's initiative.
22 October 1997
To Chairs of Health Authorities,Trusts Chairs, Leaders of Councils.
ADDITIONAL RESOURCES 1997/98
BETTER SERVICES FOR VULNERABLE PEOPLE
I wrote to you in August highlighting the importance I attach to tackling effectively and co-operatively the pressures the health and
social services face this winter. I am now writing to confirm how the additional resources secured this month can help you meet this short term agenda and to set out the direction for the medium term.
Additional Resources in 1997/98
I announced last week that an additional£269m was to be spent on health services this winter. The main purpose of this funding is to ease the pressures on the health and social care system during the winter period, but we also need to use it to provide a platform for
the future. Alan Langlands, the Chief Executive of the NHS, is writing to all Health Authorities, Trusts and Social Services Departments setting out the details. My priority areas are
-- helping hospitals cope with medical emergencies which are already known or likely to occur during the winter months, for example by improving staffing levels at times of peak pressure and through services opening extra hours
-- reducing delays in discharging patients, for example by improving rehabilitation and recuperation services, funding increased care at home, extra nursing and residential home places and more social services support
-- reduce the need for people to be admitted to hospital in the first place by strengthening primary, community and social services, providing more specialist nursing and therapy for people - particularly older people - in their own homes, nursing and residential homes, and through improved community and out of hours services
I am determined that health authorities and social services departments should work together to tackle local problems and use the money where it can have best effect.
I am also determined that this money will be used not only to improve the efficiency and effectiveness of services this winter but to
contribute to the building of better health services in the medium term. These resources, building on the work that you have already started, offer the opportunity to improve services, relationships and systems in a way that will have longer-term benefits and provide a platform for real improvements in the future.
I have charged my ministers to take personal responsibility for ensuring these additional resources are spent according to these priorities. They will be working with Regional Offices to consider local circumstances and developing a framework for allocations to make the most effective use of the money across the health and social care system.
Better Services for Vulnerable People
The new resources are a key step in our strategy to improve working between health and social care and, in particular, to develop better
services for vulnerable people in the medium-term. I want to see progress building on current good practice in three areas where I believe we can improve the fairness of the system, the quality of care and move us closer to our goal of optimising independence and promoting social inclusion. The three areas on which I want to focus are:
-- services to meet the continuing and community care needs of your local population
-- work to improve the content and process of multidisciplinary assessments of older people in both hospital and community health
-- the development of health and social care services for older people which focus on optimising independence through timely recuperation
and rehabilitation opportunities
These areas were identified as in need of focused attention through the recent monitoring of Continuing Care. They complement and support the work you are doing on winter pressures. They are integral to the policy initiatives we are pursuing in hospital admission and discharge and developing the strength of the health and social care interface.
As set out in the 1998/9 Planning and Priorities Guidance for the NHS, I want to see a new closer partnership between health and social services, based on a shared commitment to meet the needs of these vulnerable people which overrides organisational boundaries.
Alan Langlands and Herbert Laming will be writing to your Chief Executive and Directors of Social Services setting out the detail and
timescales of these initiatives. They will be an important part of the future agenda for the most vulnerable people we deal with in the NHS and Social Services and I shall be expecting them to be given high priority.
I know that your prime focus in the coming months will be on managing the immediate pressures but I am keen that we establish this development agenda now to help us manage better in the longer term.