The NHS and social care will never play nicely

Evermore founder Sara McKee says the NHS and social care will never collaborate and integrate unless the NHS sees social care as an equal partner. 

“The NHS and social care must stop bickering over funding” said NHS Federation chief executive Niall Dickson in an article for The Guardian. He’s right. There does need to be greater collaboration between these two sectors that are responsible for the health and wellbeing of the nation.

However, greater collaboration won’t come simply from increasing social care budgets.

The problem is the NHS doesn’t understand social care or what it does. Instead, the NHS treats social care like a very poor relation that must be acknowledged but really doesn’t want to spend any great time with.

This comes to light when you speak to operators across housing and social care who share anecdotes of NHS “partners” being invited to meetings to discuss the integration of services, but they never show up. The NHS is in the lead and believe they don’t need the rest of the system.

This division and class system is exacerbated by giving power to NHS England over its social care partners through initiatives like the Better Care Fund. You can see this power being exerted through NHS England threatening to withdraw funds from councils who don’t meet their measurement criteria.

This sends a very clear message. The NHS is top of the hierarchy, social care is second and housing isn’t really getting a look in at all.

So, who’s got the problem?

Within the NHS there is no ownership or a clear strategy for integrating services. There’s a lot of talk and the word transformation is bandied about, but what does that actually mean if you’re a nurse in the NHS, a care worker in the community or a scheme manager in sheltered housing?

I’m losing track of the multiple pilots, vanguards, and STPs (sticky toffee pudding in everyday vernacular!) which are just tweaking around the edges without making inroads.

There has been no significant change to hospital wards, rehab units, nursing and care home configuration or service delivery in decades. Instead, we’ve got huge legacy organisations across the system that are institutional and risk averse.

We have to talk to each other to develop new models that are centred around customer experience, better health outcomes and, as a result, much greater efficiencies in resource usage.

Let’s take small units and learn whilst trying by implementing new care models that encourage participating and engagement throughout the day by patients and staff – focusing on what people can do, not doing things to and for them.

And let’s engage with housing to provide suitable, accessible environments in local communities for people to both avoid hospital and convalesce successfully afterwards. The ultimate goal is to enable people to live in their own home, in their own community with effective transitional spaces across their neighbourhood for when they need extra support!

I think we stand a far better chance of successful change with devolved budgets like in Greater Manchester.

So why don’t we take the Better Care Fund off NHS England and put it in the community. We’ll never play nicely whilst one partner always has the upper hand and defines the rules.  And the NHS will never reduce the 4,500 daily delayed transfer statistic unless they listen, learn and understand from their care and housing partners locally.

Sara

Sara McKee

Evermore Founder and Director of Market Innovation

Follow Sara on Twitter @SaraMcKeeFRSA