6 Mar 2014

Rethinking social care: experts back a ‘fundamental shift’ in delivery

This week has seen an unusually high number of reports on the care system in England and the need to integrate the health and care systems.

Most likely it is because the care bill is in its report stages next Monday and Tuesday, with MPs given the opportunity to debate the issues.

But whatever the reason, the arguments are consistently the same, from the findings of an Independent Commission, set up by Labour and chaired by Sir John Oldham, to the King’s Fund report ‘Making our health and care systems fit for an ageing population‘, to the Independence Day Health and Social Care Hearings debate on Thursday.

All of them are urging a rethink of the way health and care are delivered. It requires, says the King’s Fund, a “fundamental shift”.

The Independence Day hearing (which I am chairing, just to declare an interest) says there needs to be fresh thinking and bold innovation.

Labour’s commission, called One Person, One Team, One System, argues for a radical new approach.

Read more: Joining up the NHS

And if there is a need to ask why, then also out on Thursday is a hard-hitting report from Age UK, which says the care system in England is in crisis.

“Older people,” it concludes, “are often placed under incredible pressure navigating a system which is confusing and unfair. Many are denied access to help, while others are forced to sacrifice what they have worked all their lives for.”

Add to this the increasing strain on hospitals with high numbers of elderly patients stuck in hospital beds when they would rather be in their own homes, the resulting cost of that care, the growing elderly population, and the case for change is compelling.

But how and with what? The agreement is around the need to co-ordinate or integrated care. Yet all too often the NHS does not talk to social services and vice-versa.

There are integrated care models where health and social care are combined to ensure the needs of the patient are met in the setting that is most appropriate but these are scattered around the country and are far from the norm.

Read more: NHS reform – a year on from the Francis report into Mid-Staffs

Then there is the debate of reconfiguration, or change. There is a profound reluctance to close hospitals, yet the ideal is for more people to be treated in the community.

This cannot happen without money being diverted from one to the other.

And there is the issue of keeping people healthier so they do not end up needing care or so they can live well with a long-term condition.

All against the certainty that at the next election, none of the parties are going to be throwing lots more money in the health/social care pot.

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