Tony Stein, chief executive of Healthcare Management Solutions, shares his thoughts on a new government white paper which proposes to make integrated care the default, reduce legal bureaucracy and better support social care.
I welcome any action by government that recognises the challenges faced in delivering care services to an ageing population. For far too long, successive governments have avoided tackling the thorny issue of how the nation organises and funds the growing care need. Whilst the devil is always in the detail and much of that is yet to come, some of my key takeaways from the paper released today are:
- The DoH paper talks of “removing the barriers that stop the system from being truly integrated” but nowhere does it mention merging NHS and Social Care budgets, the single largest barrier to a seamless care service, and this is disappointing.
- It suggests that the DoH “will work with Local Authorities to develop enhanced assurance frameworks for social care” which at this early stage seems to point to yet more bureaucracy at a time when we need to be more fleet of foot if we’re to remove barriers and reduce costs.
- The mention of increased use of technology is genuinely concerning when we look back to the billions of taxpayer’s money that has been squandered on hugely expensive and, ultimately aborted, software projects that the health service has been involved in.
- It suggests that the DoH “remains committed to the sustainable improvement of adult social care and will bring forward proposals this year”. I guess we’ll see, but the concern is that care will continue to be a postcode lottery until the commissioning and funding are centralised as Local Authorities vary greatly in their financial strength and ability to meet local care needs. The paper suggests that the new Integrated Care Systems will be deliberately designed to “enable flexibility for local areas to determine the best arrangements for them” however our concern is that this will simply translate to ‘being flexible to meet the limitations imposed by local financial resources’.
- One element of the proposal that does make for refreshing reading is that measures will be taken to address the long-term health of the nation. Unless we begin thinking of this now, we are unlikely to reverse the trend seen in the past 50 years of increasing life expectancy being matched by increasing health needs. This is an issue that requires long-term planning not short-term fixes.
- Lessons seem to have been learnt from the experiences of the pandemic thus far in that the Secretary of State is going to improve his powers to make payments directly to adult social care providers. The Local Authorities, which have had the burden of being used as a pass-through for central government funding, and care providers that have had to deal with multiple LA’s and their own interpretation for the systems, distribution and recording of this process, will heave a sigh of relief.
Reforms of any sort can look very positive when written down, it’s how they translate in the real world that is the six-million-dollar question. I truly hope that this is the start of a tangible change in the way health and social care are funded and delivered and while I remain to be wholly convinced, I will keep an open mind.