At Bettal we wish all of our friends and colleagues working in the NHS a happy 75th birthday for last week. It is a remarkable feat to endure as one of the biggest healthcare providers in the world and to have remained true to the ideal of free at the point of use for all of this time.
While celebrating all the achievements of the NHS over this time, we cannot help but reflect on the role social care has played in supporting the NHS and considering the role it might play in the future of health and social care in the UK.
Capacity over the years
In an erudite piece in the King’s fund newsletter, Danielle Jefferies, identifies how in 1951 in response to complaints the NHS was backlogged with patients who needed care in the community, the King’s Fund opened, for a period of time, care homes for the elderly.
She identifies how this issue has never been resolved with ‘delayed discharges’, because of a lack of capacity in the community (care homes and domiciliary care), meaning many people are still not being cared for in the most appropriate setting.
The recently released, and updated, Hewitt review, identifies the need for some of the barriers to integrated working between health and social care to be removed and for access to training for social care to be improved. This, the report claims will be best achieved by the government producing a strategy for the care sector to work in tandem with that for health.
There is little doubt, however, that social care is and will remain the Cinderella service in health and social care provision. The NHS Long-Term Workforce Plan, as many before it, identifies the interdependence of health and social care, but fails to address any of the burning issues like social care funding, staffing and access to training.
Instead the NHS Long-Term Workforce Plan promotes upskilling of social care staff to undertake healthcare tasks like insulin injections, but does not identify how a sector already pushed to capacity will manage this extra workload and what benefits this might bring in terms of Service User outcomes.
Recognition for social care
Hewitt recognises that social care is an “important sector in its own right”, employing as it does more people, 1.5 million, than the NHS. She urges the government to better understand the fair costs of care in its review of charging reform which should “move towards a fairer rate of care paid by local authorities to social care providers”. Such a strategy would, doubtless, help providers with issues like retention and training and help create additional capacity.
Back to the King’s Fund, who in letter to party leaders on the occasion of the NHS’s 75th birthday , identify how reform of adult social care in the UK has been “shamefully neglected by successive governments”. While, as we have seen, the NHS Long-Term Workforce Plan, is yet another missed opportunity being an NHS centric plan.
It seems therefore that the decades of recognition of the role social care play in the health and wellbeing of the nation is not about to translate into any meaningful action from any government any time soon.
As the NHS turns 75 many of the difficulties which have plagued health and social care during this period have never been resolved. Social care providers, whilst mostly willing, are not always able to play a role in helping achieve good outcomes for people because of the status of the sector when compared to health.
It remains clear that both nationally and locally social care needs reform which takes account of proper integration of services, fair pay and an equality of training and esteem for social care professionals.
Without such reform and by failing to address the lessons from our combined history, we are as a health and social care system failing to learn the lessons of history and therefore, in the words of Winston Churchill, “doomed to repeat it”.
Bettal Quality Consultancy has a comprehensive and regularly updated suite of policies, procedures and risk assessments, to support busy registered managers and their teams in the provision of CQC compliant care.
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Peter Ellis MA MSc BSc(Hons) RN
Bettal Quality Consultancy