Greater collaboration between health and social care will mean better value for taxpayers and better outcomes for service users, says John Adams
It is almost 15 years since the newly-elected Labour prime minister Tony Blair took to the stage at his party's annual conference in Brighton and declared a vision that Britain should be "the best place to grow old".
The elderly, he added, should be "cherished and valued to the end of their days". It was with palpable optimism that he announced his desire to challenge the status quo "where the only way pensioners can get long term care is by selling their home, where people who fought to keep that country free are now faced every winter with the struggle for survival, skimping and saving, cold and alone, waiting for death to take them".
Now, with the current government's white paper on social care due later this year, Blair's words have been ringing in my ears. And 15 years on, they ring hollow; Blair's unrealistically high expectations were never met. If the history of the welfare state teaches anything, it is that successive governments have shifted responsibility for the cost of social care onto the shoulders of the individual.
Under Labour, despite the fact that social care seemed to be a New Labour priority and public expenditure was on the up, it took the government three terms to publish proposals for social care reform and for the introduction of a National Care Service – and even then, publication came just weeks before a general election. While Labour appointed a Royal Commission into long-term care for the elderly, it rejected the commissions' suggestion for collective responsibility for social care funding through general taxation.
So tempting though it is to anticipate the forthcoming white paper as a once in a lifetime opportunity to reform social care, there is good reason to avoid pinning such high hopes on it. In looking ahead to what the white paper could achieve, it is worth looking back at the low priority status that previous governments have granted to social care.
In addition, we face high unemployment, stagnant growth and unprecedented public expenditure cuts. The buck for social care policy will stop with the Treasury - not the Department of Health - so we must be realistic about what it might include.
This caveat aside, what are some of the obvious contenders for inclusion in the white paper?
For starters, the VODG would like to see the implementation of the Law Commission's recommendations for a more modern and cohesive framework for adult social care. That, alongside the persuasive recommendations of Andrew Dilnot's Commission on Funding of Care and Support for reforming the unfair funding system would offer the twin planks of reform: a legislative as well as a funding shake-up.
The crucial question of how we plug the funding gap - which the King's Fund, the LGA and the Commons select committee on health have all commented on – must be addressed. But how do those of us who work in the sector reconcile the reality with the words of Paul Burstow, care services minister, that there is no funding crisis in social care (the DH later clarified his words by acknowledging "there is unmet need but also that the scale of this is difficult to precisely define and measure").
The challenge is how can resources be used more efficiently and the needs of an ageing population met. In short, how might the necessary reforms be funded within current levels of expenditure?
One important key to unlocking resources lies in the Commons health select committee recommendation for a more integrated approach to commissioning. Integration, as the committee points out, is not an end in itself, but if each area of England had a single commissioner bringing together separate pots of money, this would surely bring considerable savings. This approach, with central government periodically rebalancing spending across health, housing and social care, may offer the best hope for social care in the short to medium term.
The new health and social care architecture introduces health and wellbeing boards designed to bring together agencies commissioning health, public health and social services in a local area. In the past, a succession of similar bridging mechanisms have had limited success. Health and wellbeing boards alone will not deliver the scale of savings necessary.
The white paper must be bold in its vision for integrated commissioning and set out practical steps for ensuring the collaborative use of resources in order to achieve better value for taxpayers and better outcomes for people using services. With a perfect storm of cuts, stagnant economy and an ageing population, integration should be the white paper's watchword.
John Adams is general secretary of the Voluntary Organisations Disability Group
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Read the complete post at http://www.guardian.co.uk/social-care-network/2012/apr/26/social-care-white-paper-integration
Apr 26 2012, 04:00 AM
Healthcare Network | guardian.co.uk