Integration is a ‘smokescreen’, says report
A report by the Centre for Welfare Reform challenges the concept of health and social care integration and calls for a new, independent inspection body for social care.
Published in late March, ‘Reforming Social Care – time for radical change’ expresses doubt that any of the main political parties understand the seriousness of the situation facing social care or have the strategies to respond effectively to any of the challenges it presents.
The report’s author, Dr Robin Jackson, visiting research fellow at the University of Hertfordshire, debunks the idea of health and social care integration, citing Dame Denise Platt, the outgoing chair of the Commission for Social Care Inspection (CSCI) who, 10 years ago , said the values of social care might be similar to health but the underpinning policy assumptions were different.
“The argument that a merger of health and social care will be mutually advantageous is based on a mistaken belief that synergy inevitably confers advantages,” says Dr Jackson, who advocates a number of major reforms:
- Creation of a Department of Social Care;
- Introduction of new funding streams, including the options of: Increasing income tax; creating a tiered levy on high executive pay; creating a separate category for social care in the National Lottery
- Establishment of a Social Care Research Council, a Social Care Training Council; a Social Care Inspectorate and a Social Care Enterprise Agency;
- One-year compulsory national community service.
The report attacks private provision of publicly-funded social care, saying some of the larger companies currently providing social care in the UK are financially over-stretched, with some that are not far from financial insolvency.
“There is little appetite for companies to invest in this sector because spending on social care by austerity-hit local authorities has fallen, while costs have risen,” says Dr Jackson.
“In the event that companies providing care fail, what is there to attract new companies to come in and invest? Concern about the extreme fragility of the private care sector should prompt urgent questions as to the wisdom of permitting so much of this sector to be in the hands of private companies – many from overseas whose only interest is in generating a profit for their investors.”
Calling for a new, independent regulatory and inspection body for social care, the report criticises the Care Quality Commission’s year-on -year performance and again cites Dame Denise Platt who, in 2009, warned about the ability of the CQC to be an effective social regulator, saying it would struggle to balance its health and social care responsibilities and that the decision to abandon the CSCI appeared to have been made out of ignorance: “There was really a big misunderstanding in central government about the nature of our role. People think social care is the mirror image of health. It isn’t.”
Referring to the ‘Integration Smokescreen’, Dr Jackson’s report says power should be devolved to the lowest appropriate level and that public services and neighbourhoods should be governed and shaped from the ‘bottom up’ by families and the communities, moving away from a top-down approach to service delivery.
“While health and social care integration has been a long-term policy since the 1960s there seems to be no prospect it will be realised, because these are fundamentally different kinds of service,” says Dr Jackson.
“Focusing on integration is merely a way of avoiding the more important challenges that confront health and social care – from inadequate funding and poor governance through to deeper misunderstandings of purpose and community capacity. The first step in reforming social care must be to stop trying to integrate it with healthcare.”
- To download a copy of the full report, go to: www.centreforwelfarereform.org/news/report-on-hore-published/00370.html