The seven key principles of social care reform

Featured article - 28 March 2018
By Simon Morioka, Co-Founder and Managing Partner, PPL

Head-shot of the author, Simon Morioka, Co-Founder and Managing Partner, PPL

A whole I planned, Youth shows but half; trust God: see all, nor be afraid!

'Rabbi Ben Ezra', by Robert Browning

Ageing is not something to be scared of. An ageing population is a credit to the huge advances we have achieved in health and care; and Jeremy Hunt was right last week to highlight that how we respond is a test of the society we are and want to be. Seven key principles guide the Government's thinking: a relentless focus on quality; a whole-person view that puts people in control of their own, properly integrated, care; a well-staffed and skilled workforce, providing practical assistance in a way which doesn’t bankrupt the state, care providers or people in need. These are all welcomed, and leave little to argue with.

But in the last few years there have been various policy initiatives and it feels appropriate to ask:

What have we learned?

Firstly, that many do still talk about health and social care as if these things are separate and divisible; and that sadly, for many people, that remains their experience. Yet, Mr Hunt did highlight in his speech that this is changing – slowly, patchily, not always effectively – but in every area of the country, people are working out what integrated care might look like, and in many areas, they are getting on and integrating.

Secondly, that what we lack is not strategies, policies or plans. Where real change is happening, it is being driven from the ground – developed by local people, carers and professionals working together on practical solutions. In looking at the successes of the NHS Vanguards Programme over the last three years, it is remarkable how many of the new models pre-dated the programme itself, and how many of those involved say positive outcomes have come despite of the system, not because of it.

It is almost as telling how much innovation is being powered by individuals, voluntary and community groups – including at a national level by collaborations such as National Voices and the Richmond Group. As Paul Corrigan, former government adviser and now management consultant, has written: ‘For 5,800 waking hours a year, people with long-term conditions face their condition with the family, their carer and their friends and on their own.’ Supporting people through integrated personal budgets, improved technologies and housing, are all ways of creating a more general need to empower people and communities to live, and to live well.

Finally, we must get past the point of talking about social care funding in isolation from funding of the NHS, plus broader local government and the voluntary and community sector. The government will spend more in real-terms on health services in England in 2018 than in any previous year in the history of the NHS – over £120 billion. And yet at the same time spending on social care has fallen 17% since 2010/11, excluding transfers via the Better Care Fund; whilst overall local government spending has fallen by over a fifth.

If we are serious about improving the quality and sustainability of care, we need to stop talking about the wider determinants of health and wellbeing, and start investing in them. And that will involve co-ordinated thinking and action, beyond even the newly-formed Department of Health and Social Care.

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