Why is integration a necessary step towards strengthening the adult social care sector?
Turn that question on its head. Is having two separate sectors working? Clearly, not. It is common sense to create a seamless care system, where people are looked after, at the point of need, from the cradle to the grave. Why have a care system in which, for example, you are looked after well in hospital but then unable to get the right care package to be discharged because you are passed on to a different, unfit for purpose, under-funded and fractured sector?
Why have a system in which if you are diagnosed with cancer or heart disease, your care will be looked after and funded by the NHS until you are well or you die, but if you are diagnosed with dementia, another life-limiting disease, you will quite possibly have to sell your own home to pay for your own care. That beggars belief, surely.
Why have a system in which the Government and, via delegated authority, local health trusts look after your medical needs but it is left to your local council to take care of you in your later life or if you have disabilities. Surely it needs to be one or the other – not both.
At the moment, we are working in a fragmented system where NHS care eats up the lion’s share of funding and social care is forgotten. That is unsustainable. Had Nye Bevan known how the long-term care of older and vulnerable people has turned out, he would never have created the NHS as he did in 1948. He would have included the care of older people and those with disabilities from the start.
The Covid-19 pandemic exposed this divided system – with resources and attention focused on the NHS response and social care told at first that they could continue as normal and starved of access to PPE, testing and sensible advice for too long. People with Covid-19 were discharged into care and nursing homes with the obvious, tragic consequence. If, as the pandemic wore on, lines were blurred and NHS and social care services worked more in tandem, then that is something to build upon. But in its first opportunity to ‘level up’ NHS and social care services – the announcement of an extra £12bn of funding for health and social care over the coming three years – it soon became evident that the bulk of this, once again, would go in the first instance, to the NHS, with social care standing with its bowl out for scraps.
The NHS Confederation said that the recent White Paper could arguably be considered a Green Paper, and that there were several issues that needed clarification, do you agree?
I understand their reservations, as there are many issues within the White Paper that need to be discussed and further explored. I agree, for example, with the Confederation’s questioning how the role of the accountable person will work and echo their concerns about making an integrated system work whilst there are dire staffing shortages.
However, my major concern would be that reform of the social care sector has been delayed and delayed and so maybe a little pragmatism might not be a bad thing. It might not be perfect but let us press on and iron out the wrinkles as we go on, rather than delay.
The White Paper emphasises in particular how it will create a clearly identifiable person accountable for shared outcomes; what impact would this have on the roles of local authorities and those leading the ICS?
I think this is one of those areas which does need clarification as it is hard to see how having a single accountable person in place can work in a system which is so complex and has so many overlapping responsibilities.
As someone working in the private sector, where we are held accountable every day, I wonder just how accountable this individual will actually be? What might the sanctions be if everything does not go to plan? In my experience when something goes wrong in the private sector your financial survival or even your liberty can be at risk. This rarely seems to be the case in the public sector.
The White Paper states that 'collaboration is essential to delivering joined up care', yet Baroness Cavendish's recent report found that the NHS isn't 'human' enough for a greater social care role. Would forcing integration do more harm than good?
We need to be clear that the White Paper stops well short of the type of integration that would, in my view, create a proper ‘cradle to the grave’ care system that we all deserve. As I outlined earlier, the NHS is still the dominant ‘partner’ and gets the lion’s share of funding. It is a huge, sprawling organisation which will take an enormous amount of time to change. At the moment there is too much entrenched, silo thinking around and we have to break down those boundaries and borders to bring NHS and social care together.
We have to end the idea of NHS and social care competing for funding and have them treated equally.
Collaboration isn’t the same as integration, it still implies an element of independence rather than the ‘one for all, all for one attitude’ that we need.
We need to be bold and move more swiftly towards full integration and not settle for a continuation of the bureaucratic and disjointed mess we have at the moment.
Can successful integration happen soon, or does the government need to prioritise fixing the workforce crisis in the sector before successful integration can occur?
I think the two need to go hand in hand and need to be addressed quickly. Reform of social care is long overdue and what has been achieved has been modest and piecemeal. Tinkering with the edges of social care doesn’t move us towards delivering the truly integrated service we desire; it merely postpones it yet further. Integration cannot work without proper reform of social care funding and vice versa. To bring it about successfully, social care funding needs to be improved and placed on an equal footing, in terms of priority, with NHS funding.
