Social care: a tale of two countries

You wait for ages for a review of social care, and two of them come at once.  One is in Matt Hancock’s rather strangely timed proposals for reform of the NHS; the other is the Feeley report for the Scottish government, proposing a National Care Service for Scotland.

The English report has the catchy title, Integration and Innovation: working together to improve health and social care for all – I wonder if  they hired a consultant to come up with that one?  It’s a proposal for legislation on a range of topics, but lots of topics are listed as the subjects of a forthcoming bill, and the topics that are listed are difficult to match to any text that lays out the rationale.   In relation to the integration of health and social care, the main proposal seems to be that there will be a law telling people they will have to collaborate more eagerly. We all know, it seems, that the real problem is that we need a supervisory body to bang heads together.  And that, as far as I can tell, is about it.  Not a word about finance, or budgets, or professional barriers, or liaison, or … much at all, actually.  I can’t help feeling that I’m missing something, but I can’t tell what.

The Feeley report, by contrast, is rather good.  For one thing, it starts by asking people, both service users and professionals, what the issues are it needs to address. It points, for example, to the current arrangements for getting specific services to people: “It’s the equivalent of NHS staff having to make a case for funding every time someone needs a blood test.”  The panels knows that care workers are woefully underpaid.  It recognises, as the Hancock report doesn’t, that there has to be money.  The report argues:

There is a gap, sometimes a chasm, between the intent of that ground-breaking legislation and the lived experience of people who need support. In the improvement world, there is a maxim which reads something like “every system is perfectly designed to get the results it gets”. … We have inherited a system that gets unwarranted local variation, crisis intervention, a focus on inputs, a reliance on the market, and an undervalued workforce. If we want a different set of results, we need a different system.  … We need a transformation of the way in which we plan, commission and procure social care support.

I don’t agree with everything in the report, but that’s what happens if people who know what they’re talking about make their case with a rationale  and evidence.

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