In an exclusive column for Home Care Insight, Care England chief executive Professor Martin Green sets out his vision for social care.
It is now over 23 years since Tony Blair promised a solution to social care funding and five Prime Minister‘s later, they have all made grandiose promises, but nobody has delivered.
We have been on the brink so many times, expecting announcements to be made, which are then pulled, or do not deal with the issue in a holistic way. I believe we need a radical new vision for social care, and it is only when we get this new vision, that we can work backwards and identify how much it will cost to deliver something that is of high-quality, meets the needs of citizens, and is sustainable in the long term.
One of the many problems with our current system is that it only supports people when they have gone into crisis. Despite all the rhetoric about prevention and integrated services, the reality is that unless you have a critical incident, or significant decline, you are not going to get support.
Supporting people to live well
When thinking about our new vision for social care we need to establish a system that supports people to live well, and where the interventions are made in a timely fashion that stop people going from one level of dependency into another. If we are able to craft a new vision that is very much more preventative, this will not only be good for individual citizens, but it will certainly be good for the whole of the health and care system and for public expenditure.
Health and social care are interdependent, and it is foolhardy to do what we have done over many years, which is to focus on health and ignore social care. The NHS has so much to commend it, but it has now become almost a national religion and any suggestion that we need to change it or make it fit for purpose in the 21st century, is dealt with as a heresy. At the start of the COVID-19 pandemic, the NHS withdrew from much of social care, and we saw that social care staff were able to perform any of the functions that had previously been done by their NHS colleagues. This new reality should offer us a platform to ensure that when we decide who has to do what, we do not focus on the organisations and processes around health and social care, but rather we shift our focus onto people and outcomes, and this will be a part of defining a new approach to integrated health and social care that will be truly fit for purpose in the modern age.
If we are able to craft a new vision that is very much more preventative, this will not only be good for individual citizens, but it will certainly be good for the whole of the health and care system and for public expenditure.”
Politicians and the media are often obsessed with the notion of organisations and there are endless discussions about whether the NHS, or private providers, should be allowed to do a range of functions. When you talk to citizens however, they just want good quality care and support, that is delivered in a timely fashion that meets their needs and enables them to live well. It is only when we start measuring services on the basis of, the experience of those who use the service, on the outcomes that are achieved and the way in which money and resources are effectively used, will we be able to truly craft a system that does meet people’s needs, rather than the needs of an organisation or brands.
As we look towards the future, we should also examine all the quangos that surround health and social care and ask some tough questions about whether or not they are delivering what we need. Throughout this pandemic it was noticeable that there was a serious data gap within social care, and this must be used as a platform to identify what data sets will help us to deliver better services, and particularly, to deliver those services at times of crisis.
At the start of the pandemic, we saw the ONS delivering figures on deaths in care services that was sometimes 10 days out of date. I do not know how it is possible in a digital age, to have such a long delay before we get statistics and data. When there were challenges to this from politicians, the Care Quality Commission said that they could provide this data, and some tough questions need to be asked as to why they were not doing it in real time from the start of the pandemic.
Health and social care are interdependent, and it is foolhardy to do what we have done over many years, which is to focus on health and ignore social care.”
As we think about a new vision for social care, I think we need to examine all these quangos and ask whether or not they need to change and develop to meet our needs. I want to see a regulatory process that is far more about how we forensically examine critical incidents and learn lessons that are cascaded across the entire sector, so that every single investigation gives us some indicators on how we can reduce problems and improve quality.
We also need to look at the role of organisations such as Public Health England, who throughout this pandemic delivered guidance, which in some cases, was changing up to 4 times a day because it clearly had been written by people who did not understand social care. If we are going to have an integrated system, we need to ensure that all the agencies of government have representatives of the sectors that they are supporting. Currently much of the infrastructure is staffed by people who only know the NHS, and this has got to change.
Integrated care systems
There is another tendency in government, which we have seen played out over many years, and that is to change structures in the belief that this will deliver a change in the way things work. The latest in these long line of changes, is the arrival of the integrated care systems. These new systems are heralded as the thing that will integrate health and social care and lead to a better experience for people who use services. I am sceptical because I am old enough to have lived through many reorganisations that brought us joint appointments between health and social care, whole systems approaches, PCT’s, and of course, CCG’s, none of these changes delivered the Shangri-La that was promised. Partly, that is because the Government is incapable of understanding that it is not structures that need to change, but cultures, and if you change structures and recycle the same staff without going through a proper approach to culture change, you will never change the system or the outcomes.
The government is incapable of understanding that it is not structures that need to change, but cultures.”
There is pretty universal agreement that we do need a new vision for social care and we need to sort out a long-term and sustainable funding settlement. However, I think we need to go far beyond this, we need to reposition social care, but we also need to be mindful of the fact that we are now in a queue of many people who are requiring money from the Exchequer. In light of this we have to build back better and stronger, but also, we have to build back in a way that is efficient and shows the investment is delivering outcomes. Unless we clearly see the tangible benefits of reform, it will be a very hard sell to the Treasury to get the money needed. There is all to play for, but we must be clear, focused, and united if we are going to achieve the reform that we have waited so long to achieve.