A ruler isn’t a magic wand

Posted on July 18th, by geoff in CT blog. 3 comments

By Caring Times editor Geoff Hodgson

Writing in The Guardian last week, Care Quality Commission chief executive David Behan said too many people were being failed by the ongoing disconnection between health and social care – https://www.theguardian.com/social-care-network/2016/jul/14/joined-up-health-and-care-david-behan

Mr Behan tells it like it is: he acknowledges the Government’s stated desire to integrate the health and social care systems but says there is too much of a gap between this ambition and the experiences of people using services.

There is one thing he said, however, that raised my eyebrow: “It’s time to create a way of measuring integrated care.” I know that by measuring something one can show it to be inadequate, but the act of measurement does nothing of itself to improve a situation. And recent governments have shown themselves to be very resilient to being beaten on the head with a measuring stick, viz. social care funding and the appallingly poor access to health services for care home residents with dementia – all well-documented and quantified.

Were there to be a consultation on ‘how do we measure health and social care integration?’ I would suggest that the time elderly people spent in limbo in a community hospital, waiting for health and social care to begin delivering an appropriate care package, would be a useful index.

But measurement aside, an integrated health and social care system will only happen when we have a truly integrated health and social care budget. I believe that this could only be done by a fundamental dismantling and reconfiguring of the present administrative structure, and I don’t see that happening anytime soon.

  • The CT Blog is written in a personal capacity – comments and opinions expressed are not necessarily endorsed or supported by Caring Times.

3 responses to “A ruler isn’t a magic wand”

  1. Completely agree. For example, Devon carried out a full investigative response to its judicial review findings, bringing in Ernst & Young from the ‘big 4’ accountants. Devon’s eventual official response was and is that it will not pay a care fee that enables a profit and it will only pay a fee that covers overheads. Need one say any more? Only supply and demand can bring sense.

  2. I wonder if CQC isn’t coming up against its own self-imposed limitations here, in that David Behan has always been explicit about CQC being a regulator and not an improvement body – and therefore, by definition, reacting to what’s happening on the ground rather than suggesting what might be done differently. My sense is that in many places, health and social care are estranged and with too many pressing issues of their own (often financial) to find the time to explore how they might do things differently. If there is to be a ‘reset’ (i.e. reduction) in hospital finances this week, this could turn them even more inward-looking and exacerbate the position.

    At present, neither NHS Improvement nor CQC is set up to look at quality from a system-wider perspective. But there are things they could be doing in the meantime. Although NHS Improvement has no remit in relation to social care, it would be interesting to see if CQC and NHSI could make some common cause around thinking about what a systems approach might look like, encouraging more joined-up working, or even adding to the evidence base around what was happening around the country and where progress seems to be underway. It’s not going to happen on its own.

  3. Jon Chapman says:

    I would agree Geoff. Until the NHS sacred cow is killed it will be impossible to divert the huge sums it wastes into a more efficient integrated system. Killing the cow shouldn’t be too difficult – it is after all ring-fenced!!

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