Health and social care must merge, says Wales ombudsman Peter Tyndall

Mr Tyndall says the current social and health care system is too complex

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The way health and social care is delivered outside hospital must be radically transformed, a watchdog says.

Public Services Ombudsman Peter Tyndall, who leaves his post next week, said the system is too complex and wants one body to manage services.

He called on Health Minister Mark Drakeford to review home care services.

The Welsh government said it intends to fully integrate health and social services but the solution does not lie in structural change.

Start Quote

We need to be much better at delivering integrated packages of care than we are at the moment”

End Quote Peter Tyndall Public Services Ombudsman for Wales

Mr Tyndall says that it puts huge stress on families and carers whether they are looked after at home or a nursing care home.

"We need to be much better at delivering integrated packages of care than we are at the moment and that will need structural change," he said.

"Many more people are living in the community and receiving support - particularly older people.

"Often that support is coming from private or voluntary bodies; on the other hand, you have nursing care from the district nurses, occupational therapists and physiotherapists and so on.

"We need to look at that as a single joined-up entity instead of the fragmentation we currently have.

"It's all very well to say to people to share budgets and so on, but why do you have separate budgets in the first place?

CASE STUDY: 'Complex and stressful' care system

Helen Jones from Porthcawl cared for her mother for two-and-a-half years before she died last year. Cynthia Molkner, 83, was diagnosed with advanced vascular dementia in 2009 and her daughter explains the pressure she felt under to care for her at home.

"Initially, I was somewhat traumatised. I had no medical training and was sent home with a carrier bag full of pills that I was supposed to administer to my mother and no details of how to do so. So I panicked, rang the hospital and then was put in the picture.

"But the first week was taken up with trying to stop being traumatised and trying to make my mother comfortable and she was of course distressed because her circumstances had changed... she didn't know what was going on.

"The system is hugely complex.... and therefore incredibly stressful.

"Trying to get your head around some of the complex paperwork and so on that you're faced with is a complete and utter nightmare.

"And you're trying to turn yourself into a medical administrator at the same time as looking after a loved one which is virtually impossible.

"I like to think of myself as intelligent, but I needed a legal brain to assist me.

"The complexity is phenomenal. There are things like decision support tools, care domains, tick boxes, low, moderate, high, severe, priority...

"You're being visited every five minutes by either a district nurse or a community psychiatric nurse or a social worker and you're trying to fit all these people into a busy schedule while you're looking after a loved one who is calling you sometimes 150 times a day."

"Why do you have separate agencies in the first place? I think that's a historical accident and it needs to be corrected."

Mr Tyndall said the the current system puts pressure on the health service as a whole.

"It has an effect all the way back to accident and emergency [hospital departments] because if people are occupying beds in wards needed by people in A&E then people are waiting to get into A&E to be seen."

Mr Tyndall spoke to BBC Wales ahead of his departure from the post next week after being appointed as Ireland's Ombudsman and Information Commissioner.

'Inappropriate admission'

A Welsh government spokesperson said both the health minister Mark Drakeford and the deputy minister for social services have stated an intention to create "fully integrated health and social services".

The spokesperson added: "A significant amount of work is taking place in this area as a result, including consultation over the summer on how we can meet the health and social care needs of older people with complex needs.

"Our draft budget for 2014-15 includes proposals to establish a £50m Intermediate Care Fund, which will support collaborative working between social services, health and housing.

"It will be used to avoid unnecessary hospital admissions, or inappropriate admission to residential care, as well as preventing delayed discharges from hospital.

"The aim will be to support people to maintain their independence and remain in their own home, as well as ensuring beds are available for those people who really need them.

"The solution does not lie in structural change but in encouraging people and organisations to work collaboratively," the spokesperson added.

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