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I think the Government can draw much-needed lessons from two healthcare topics currently in the news. They seem different, but they show a worrying trend in how care support and healthcare support are imbalanced.
Firstly, hospital trusts in England are putting their foot down and refusing to agree to new funding arrangements intended to come into effect from April. NHS providers is an organisation representing the interests of hospital trusts. They say that the current plan to axe a further £1.7 billion from funding would put patient safety at risk, and so reduce the number of people who can be admitted for healthcare. They stated that this would represent a fifth year in which funding has been reduced, and it has now become intolerable, making safe care impossible.
Open, come what may
The social care sector, of course, has had a similar year on year funding reduction in most areas. A major difference is that small local services can shut down, albeit to the detriment of the local community, if they become financially unviable. Hospitals, on the other hand, remain open, come what may, being relied upon by the public in life or death situations.
But NHS services have had to cope with the effects of reduced social care. We read this winter the accounts of bed-blocking where there is no home support to enable people to be discharged, of people being accommodated in temporary accommodation in hospital car parks, and the apparent failure of helplines to reduce the pressure on admissions.
The second current topic is the continued lack of action on the promised changes after the Winterbourne View scandal. The investigation after the abuse and inappropriate care of people with learning disability at that hospital recommended that people should be placed closer to their family, in smaller units for shorter term care. As the Bubb report of last year pointed out, there has been little action taken. Although some people have been placed elsewhere, hospital places are still taken up by new admissions. What is needed, it emerges, is a program of closures, supplemented by alternative community care closer to people's homes.
Reducing the emphasis on hospital admission
The parallels here with the funding crisis in the NHS is plain: healthcare is provided in institutional, large scale facilities, and many of these struggle to maintain the quality of service that should be provided. The solution in both cases is similar also; people with learning disability need shorter-term, more local care, and the Government acknowledges the need for more preventive, local health provision to reduce the ever increasing emphasis on hospital admission. Rather than being health facilities, hospitals are primarily where ill-health is treated. And the proposed alternatives are more genuinely health focused in their preventive efforts.
Sir Bubb's proposals for partnership working, local co-commissioning and, above all, involving people and their families in decisions, are promising factors in working to a preventive, health based approach. Equally the Government and NHS recognise the need for smaller, more local healthcare to supplement hospital stays. This is part of the reason why trusts have a reduction of another £1.9 billion to help establish the Better Care Fund, which is meant to provide healthcare in communities and at home to relieve the growing pressure on hospitals.
Will it happen? Will care and health services move towards a more preventive, collaborative, small scale and involving mode of operation?
There are promising signs. The Better Care Fund shows promises to meet people's health needs in a less crisis-focused and more local way. Equally, the recommendations of the Bubb report point to an innovative and people-focused direction for smaller, more preventive care services.
Policy statements too point in the same direction. In Scotland the government is beginning an extensive consultation on the future of the NHS in Scotland, called Scotland 2020. The Health Secretary, Shona Robison, says that "We need an approach to health in Scotland that fits the 21st century. We have the 2020 Vision. That vision – with its emphasis on new models of care, on healthcare delivered closer to home, on prevention – remains the right one... I want to work with stakeholders, including patients and families, professionals and clinicians of all stripes, the Health and Sport Committee and opposition parties."
And in England, there has been the Five Year Forward View, a plan to restructure NHS England on more partnership, preventive and participative working.
The next 10 years in health and social care services will be interesting ones. Under the pressure of increased demand and reducing funding, agencies are recognising that the people of this country need more local services which will promote prevention and an increasingly healthy lifestyle. If the funding and original thinking required can be brought together, it promises to be an exciting and improved context for all health and social care services.
Tony Clarke – QCS Expert Scottish Care Contributor