.The Future of Social Care and Health- A User’s Perspective

We often hear about the need for significant investment within the social care system and at the same time, the NHS also requires some major funding. I've read arguments for both. 

Which is more important? Where is the greater need? Both sides seem to be fighting for recognition and action and perhaps there is a third option... 

As a user who has been through social care system for my needs to be met and subsequently moved over, due to increasingly deteriorating health, to the NHS system of Continuing Health Care, I have seen both the benefits and the issues with both systems. Clearly, there is a need for social care and there is a need for health and we have one governmental department for both, so why not have that replicated locally?

 

I'm proposing a new single system that transitions from social care to health seamlessly. One department run by the NHS and managed by the new ICS (formally CCG's). As a user I see both systems running along the same tracks, the assessments and processes are the same. Regardless of what the organisations call it health or care, does it really matter? The end result is that we look after those in need.

 

As a voluntary advocate helping people through the processes, it is easy to see a single clear process made from an amalgamation. It doesn't really matter what it's called. Having worked for a Local Authority for a number of years I know that if you ask someone who they would prefer to, for example, collect their bins, county or district council, most people would say they don’t mind, they just want and need it done. It's only the organisations themselves who worry about which sector who it falls into. Similarly, people just want social care and health systems fixed.

We have numerous pieces of legislation and statutory guidance that say both social care and health should work together and there may even be some senior combined working, but when you get it down to service users’ level, it's like playing pass the parcel. The mentality of budgets and who's going to pay what causes huge stresses to those in the middle. One department based on the principles of personalisation, which both organisations recognise, would ensure a seamless system. I really believe that this is possible and the cost savings would be astronomical to both. The legislation behind the ICS change highlights the need for close working, but it won't happen as before, unless we make it happen.

One area that stands out as costly and non-essential, is the constant checking and rechecking done by both organisations when carrying out assessments or reviews. It makes no sense to have trained staff go out to do assessments, where they have spoken to the user and fully understood their needs, to then be checked by two other people who say what they can and can't have. Doubling and sometimes tripling the process is both costly in time and resources. 

 

These checks aren't even required by the legislation and are purely hierarchical and unnecessary managerial oversight for no other purpose but to keep within departmental budgets. I often see that the additional costs of this oversight, is equal to or often more costly than what is being required by the user in needs. Again, even though guidance says, reduce checks and unnecessary paperwork, I, and many other users, are seeing this pattern of working increase, which is creating more work for the organisations.

I would suggest the entry point for care or health be the GP services who the ICS/CCG already work with. They already have all the medical records and for most people are the first port of call for help or treatment. They should, with their medical knowledge, be in ideal position to ensure what needs for care and health are required. Why would you ask someone else to assess when the best person or closest contact to the services knows or has access to the information needed to gather the full picture of what the user requires?

The inclusion of social prescribing at local GP's naturally fits in to the picture and can help support some of the needs and reduce some costs to both the NHS and Local Authorities.

Carers should be included in the conversations too, and for family or friends of the dependant it should be up to the carer to determine how much they participate in caring. This also needs to be backed up and recognised by appropriate pay for their services and a minimum of respite dependent on the contribution they give to caring. The argument here is simple if you don't look after the carers this will have a severe costly impact on health and care services when already too many are at crisis stage.

The other serious issue is that there are not enough paid care workers within the industry to meet the need. People often do not see it as a career pathway with a degree to work through or future behind it.

The solution to this is to stop paying care agencies. It seems ridiculous that you pay an agency twice what you pay for individuals who manage their own budgets and yet they do the same job. Appropriate pay structures and educational achievement managed by users or their internal support structure would reduce costs and promote personalisation at the same time.

With an increase in knowledge and training, to perhaps learn some of the basic health needs i.e. monitoring record keeping, basic first aid, would lead to a natural progressing in to nursing should the paid carer workers want to explore that path.

There are many other areas I can think of for both social care and health which would fit naturally in to this single system and ensure maximum savings, a better unified system at reduced costs all for the benefit of the users.

However, before any of this happens there needs to be a recognition that we can't fix one or the other alone, fix them both through one new agency. A fresh open look needs to be taken, no more tinkering with the edges. Do it right and most importantly involve users from the start to preproduce rather coproduce.