Health and social care need radical reform
The crisis in social care is well documented, with numerous heart-rending stories of people unable to access basic care due to the significant cuts local authorities are facing since the austerity regime began back in 2010, writes Waheed Saleem. He lays out his thoughts on some of the innovations that could help reform social care – an issue that is set to become an even bigger political hot potato at local and national levels for the remainder of this parliament and beyond.
Despite the significant cuts faced by local authorities, there does not seem to be the radical solutions required in the face of such cuts, even though back in 2010 the significance of the cuts were well documented. It seems that complacency and inertia have been the’ order of the day’ as the traditional public sector mentality prevailed: it will be someone else’s problem in a few years time; the Government will capitulate and give more money; or we will deal with the problem another time.
In the commercial world, faced with the known fact that there will be significant cuts in income over the next few years, businesses would be innovating and radically changing the way they operate, although the comparisons may not be directly applicable, in that social care is provided within a statutory framework and within a wider political environment, the lessons of survival of the private sector can be useful.
Any major business facing a significant slow down in the market would consider a number of solutions in order to survive, including but not limited to: merger or acquisition; significant cost cutting to reduce waste and inefficiencies; greater use of technology to improve efficiency; innovation and transformation and reducing layers of management and staff.
There are lessons to be learned for social care and local authorities, which any forward thinking and innovative council would have started to implement back in 2010 and would have reaped the benefits now. Thus, instead of having to make tough political decisions on reducing vital services, they would be providing high quality efficient services and continuing to improve and innovate.
What would this mean for local authorities and social care? Firstly, the merger of health and social care should have been planned and delivered in 2010. However, NHS and social care leaders continued to tinker at the edges arguing about delayed discharges, fire fighting and protecting their own territory, without thinking of the wider system and citizens.
The mantra in the NHS leadership ‘speak’ is system leadership, yet the same people have in the last six years been in leadership positions, therefore if they were unable to provide system leadership previously the chance they can now is debatable.
There is still time to develop a comprehensive integrated merged system across health and social care, with one budget, and redefining the boundaries and traditional service provision between health and social care. The Sustainability and Transformation Plans (STPs) were supposed to be a mechanism for this. However, from the plans I have seen, STPs fall well short. Once again, plans have been developed that tinker at the edges and are neither transformational nor sustainable.
Social care has continued to be procured and delivered in the same old way as as been the case for the last 20 years, despite reductions in funding, changes in the demographic profile and needs of the population. Local authorities continue to ‘commission’ hundreds of providers to deliver social care services, mostly in the private sector, paying minimum wages, with significant turnover of staff, no time to offer care to vulnerable people and complete inefficiency and bureaucracy in managing hundreds of contracts, trying to regulate the market with little success whilst continuing to provide substandard services to citizens.
So what would I do to innovate and develop a new social care offer? The integration with health would enable better management of vulnerable citizens, thus every older person, disabled child and mental health patient would have an integrated plan, developed by their case worker, who could be a social worker, mental health nurse or district nurse, all working as part of an integrated team managed through a single management structure with a single budget to determine the most effective intervention required for the individual based on their need, within the legislative framework.
The element of care would be provided through place-based social enterprises, providing community-based approach to supporting vulnerable people to live independently in their own homes or in sheltered accommodation. The social enterprises would encourage volunteers from the local community to support vulnerable people as well as the element of paid staff, thus communities looking after their own.
This approach would mean removing private providers and diverting the funding to the social enterprises, who would work as part of the integrated health and social care supply chain, enabling a flexible approach to provision of care services to support prevention and early intervention, with strong social connections being developed with the citizens and moving away from the impersonal bean counting services currently being provided by companies requiring to make a profit.
The development of an innovative integrated model of care would enable the reduction of the number of staff required to manage the social care market – social care departments have large numbers of people ‘commissioning’ social care services – and the consequent reduction in managers. Thus, saving money and improving care for vulnerable citizens.
The investment in technology can provide significant improvement in care and reduction in costs. Social care services are significantly behind the curve in developing technology, thus only tele care and call technology has been used in recent times. However, the innovation is IFR technology, remote monitoring and robotic technology could significantly improve care, support people in their own homes, detect problems before they occur and ensure the most appropriate intervention in an event of an emergency.
There is an urgent need to bring in new innovative leaders who have the courage, understanding and foresight to develop the new response to the significant challenge faced by health and social care. The present system and leadership has failed, therefore, a new approach is required. I fear that this response may never become a reality, due to inertia and narrow minded leadership.
Waheed Saleem is a health and social care consultant, who has worked at senior roles in the health service.
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