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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5 reader comments

  1. H Statton says:

    A little bit out of synch but I’m not sure where else to make this comment. It is true that our population is living longer but I fear that the life-span of the average person may start to go into decline as peoples lifestyles are changing.

    More people are suffering diseases normally associated with middle-age and upwards at a younger age: Heart disease, type II Diabetes, even cirrhotic liver disease in people as young as their teens and early twenties. It could end up being a case of the would-be medical condition outlives the patient i.e. a patient at high-risk for insulin dependent type II Diabetes does not live out their expected life-span; they do not live long enough to develop that disease as they may die from premature cardiac disease.

    There has been a massive shift in what we tend to eat now than say 40, 50 years ago. More hectic lifestyles and convenience foods mean we don’t get the time to be as active, and we spend less time preparing our food. We tend to need things ‘now’. Plus, at present it is sadly not always cheap to be healthy.

    Maybe we can expect a different ‘type’ of patient in a hospital bed in the not-to- distant future. It may not be an elderly person it may be someone that needs medical attention that they simply cannot receive at home e.g. a patient that needs on-going cardiac monitoring.

    I can imagine a transition period where there is an overlap between treating the elderly and the younger populations for the same illnesses and this will put immense strain on patient care. An elderly patient may need palliative care at home but also require intermittent hospital admission for a condition that requires round the clock attention. Who is going to make the decision as to which patient gets the bed and what happens to the patient that doesn’t get the bed? What if there aren’t enough beds?

  2. Chris Forest -Potter says:

    The gap between health and social care has always been debated with no resolution. What needs to happen is for more Community staff to be given the time to care for people without time limits and constraints against those workers. We also need to return to basic common sense

    1. Jack says:

      I couldn’t agree more. Lancashire Social Services have been going through massive changes over the past four years that it is hard for staff to keep up with policy and procedure and staff have been given voluntary redundancy, other’s have had enough of lack of resources, staff and poor management. Hospital discharges has and always will be a bone of contention in that hospitals are far too often keen to discharge people back home. Many of the social care staff are unqualified and I will say, very professional, yet they are having to deal with a complex system with many legal implications with absolutely no management support. They are required to make decisions based on evidence from case records, family and the patient but when it comes to a decision that they feel it would be unsafe to discharge a patient home, even with care in place they are bullied in to giving in to the decision arrived at by the medical staff. This is because management doesn’t have the guts to back their own staff. Similarly, the community teams are only just getting to cases referred six months ago…. many have died before team members can arrange appointments. Health and Social Care do communicate and I can say without any contradiction that Health have the final say. I imagine more cuts to come thus adding to an already service that is in crisis.

  3. Alan says:

    Given British lawmakers financial interests within the private health/insurance sector, the result will be profitable. At last count nearly 200 MP’s and Lords declared personal financial ties to the industry. Conflict of interests appear to be the order of the day.

  4. Philip Edwards says:


    Want to bet “fundamental change,” “debate of reconfiguration” and “change” actually come to mean more rip off privatisation to help tory, New Labour and LibDem chums trouser more profits?

    All the rest is nonsense.

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