This guest blog was contributed by Kate Gridley, Research Fellow, Social Policy Research Unit/School for Social Care Research, University of York.
It was with tentative optimism that I read the short paragraph in the Government’s recently published social care white paper that proposed that everyone with a care plan should be allocated a named professional to take responsibility for care coordination. The importance of on-going support to help people access and coordinate services, for example from a dedicated case manager, was a key finding of the research we recently carried out at the Social Policy Research Unit (SPRU, University of York) into good practice in social care for people with severe and complex needs.
For this study we consulted people with complex needs (including older people with dementia), family carers and members of specialist voluntary and user organisations, about what they consider to be good practice when someone’s needs are severe and complex. In addition to a person centred approach to everyday care and support (for example from a known and trusted helper ), participants valued person-centred support to arrange and coordinate care, over time, from a case manager or other individual who knew them well and had expert knowledge of their needs and the services available to them.
When we carried out a literature review to scope the evidence on good practice for people with complex needs, we were disappointed to find little robust evidence about what works. However, there was some evidence in support of intensive case management for older people with severe dementia. In a study by Challis and colleagues (2002), older people using a community mental health service who received case management had reduced needs compared to older people using a similar service with no case management, and their carers experienced less stress. What’s more, after two years 51% of the case management group were still living in their own homes, compared to only 33% of the comparison group.
Care coordination should be person-centred
If the government is to improve care coordination for people with complex needs, as indicated in the white paper, the message that care coordination should be person centred is an important one. Much of the focus of personalisation to date has been on the delivery of person centred direct, everyday care, but participants in our study stressed how important it is to be treated as an individual by those people who organise and coordinate services as well.
This requires consistency in who provides care coordination, and a long term approach, to anticipate problems and prevent crisis. It also necessitates a certain degree of expertise on the part of the case manager, to understand more complex needs and be able to navigate complex service systems. For people with severe and complex needs who may not be in a position to arrange care and navigate services alone, such an approach could be key.
The research was funded by the NIHR School for Social Care Research. The views expressed here are those of the authors and not necessarily those of the NIHR School for Social Care Research or the Department of Health, NIHR or NHS.