Action to tackle the growing crisis in health and social care is essential for a sustainable future

Today we publish our agenda for action to tackle the growing crisis in the NHS and social care. The aim of the agenda is to build on our analysis of finance and performance in the NHS by outlining what should be done by government and NHS leaders.

It draws on our work in relation to three big challenges: sustaining existing services and standards; developing new and better models of care; and reforming the NHS from within. It also sets out our views on the additional funding needed for health and care.

Sustaining existing services and standards requires a renewed focus on better value, by engaging clinical teams in reducing variations and improving how care is delivered. It also requires organisations to work together in place-based systems of care to decide collectively how to use the resources available to them. One of the most urgent priorities is to tackle workforce shortages and make working in the NHS an attractive career choice.

Developing new and better models of care should start by giving people more control over their own health and care. It should place much higher priority on prevention and public health through greater collaboration between the NHS, local government and the third sector in population health systems. And it should accelerate progress in the implementation of integrated care through specialists working more closely with primary care teams and general practices collaborating in federations and networks.

Reforming the NHS from within requires the NHS to adopt a quality improvement strategy in which every NHS organisation makes a board-level commitment to quality improvement. National bodies should change the way they work with NHS organisations – adopting a more proportionate approach to regulation and inspection, offering practical support to organisations in difficulty, and creating an environment in which innovation is encouraged and rewarded. Much higher priority should be given to valuing and developing leadership, including clinical leadership, at a time when there are difficulties in filling top-level vacancies.

As well as addressing these three big challenges, the NHS and social care will need additional funding. While there are many opportunities to deliver better value and release resources in the ways we have described in our work, we do not believe this can be achieved at the pace and scale needed to deliver improvements equating to £22 billion by 2020/21. An honest debate is needed on how to fund health and social care on a sustainable basis.

This should build on the work of the Barker Commission, with the aim of bringing public spending on health and social care up to 11–12 per cent of GDP by 2025. More immediately, it is not credible to expect the NHS to manage within the very low spending increases in budgets which the Spending Review provides for in 2018/19 and 2019/20. Without additional funding the growing crisis in health and care could become much worse, with patients waiting longer for treatment, quality of care compromised, and fewer people receiving publicly funded social care, which is already stretched to the limits.

The proposals set out in our agenda are the essential actions needed to ensure the NHS and social care can be both sustained and transformed. Failure to act will result in the slow but steady decline of services highly valued by the public. The NHS will survive, but an unwillingness to recognise publicly what is well-understood privately by leaders across England is simply storing up much bigger problems for the future.

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Comments

#546008 Pearl Baker
Carer/Independent Mental Health Advocate and Advisor/trust Governor
Independent

'Innovation' has always been with me as a Carer. I have been looking at other ways the Mentally Ill can be supported in the Community, choosing their 'Health & Social Care' providers including HOUSING. The 'package'.

I have been studying how a Housing Association can claim 'Intensive housing management/housing service delivery' when the LA have already contracted out this service to their Private management Company?

The question is does this fit the 'exemption' definition, which allows the HA to charge 'massive extra charges to the tenants Housing Benefit claim form?

There are 4 criteria for the Landlord to be fulfilled; before he can claim the 'massive' charges referred to above.

'The additional services to meet those needs ("additional/Intensive housing management) must be provided by the landlord or an agent or an agent on its behalf'.

The 'Client' has an 'identified need' and a 'Care Plan' or in the COP a Deputy. The question is why is the HA allowed to 'add' in this 'massive' HB charge?

I have proof that the LA Private Management Company is Contracted to provide all these services for their client, the same provider has a Contract with the Housing Association, at the same time claiming to provide the same services the LA have contracted out to a Private Management Company.

'If the care, support or supervision is NOT directly provided by the Landlord or by someone acting on their behalf, for example if all the care, support and supervision are independently commissioned by Social Services, then "exempt accommodation" status will NOT apply (HB/CTB Circular A22/2008'

So the question is WHY will nobody from the LA Housing Benefit section listen to my concerns? why does the Head of Revenue of West Berkshire Council ignore my email to him? the answer is VERY CLEAR.

The LA are refunded all the 'Intensive Management Charges/Housing Service delivery a 'massive' £33 a week each of these tenants. by an annual 'subsidy' by the DWP.

I have quoted the regulations, and what is actually happening! I will leave you all to make up your minds if this is 'illegal'

I come back to my original question: if a Carer was in a position to provide appropriate accommodation and claim 'Intensive Housing Management/Housing Services delivery' in addition to a rent, and provide All the Care and Support, via a 'needs assessment' 'Care Plan' 'financial support' from the LA to provide 'additional needs' this would ensure the Mentally Ill at least would be CARED for.

The SAVINGS to the LA and the NHS would be substantial.

The LA would provide emergency contact numbers to the CARER/Client.

I have been a Carer for thirty years, I have NOT contacted the LA in ALL of that time. I am an Appointee for their Welfare Benefits, and have managed without any help (Accept the initial years, when a GP and Psychiatrist was always there for me). This individuals has a quality of life beyond belief, supported by his friends, (who happen to be a Social Worker) teacher, and others in a Professional capacity (but friends of our family).

If I have found my way works, is successful, no hospital admissions in all of twenty years, no LA input, no Psychiatrist input, JUST ME, then you should be listening to how I achieved this.

I CARE for two family members who suffer from Schizophrenia, one CARED for by me, the other the LA denied Carer Status. I now Care for him, I launder his cloths, purchase food, and escort him to London to visit his Psychiatrist, can YOU see the difference, without my input would continue to look like a 'tramp' dirty and uncared for.

#546009 Terry
Retired

You are trying hard I know but there is more of a fundamental problem. Getting and keeping quality staff who can not only lead but do the practical job well. There is a wealth of good people out there but a growing number allow facts to be quoted that show that 8000 people are dying every year in English hospitals because of avoidable mistakes. I repeat again from mistakes. This outstrips traffic accidents.
Is it a case that many doctors are held back by there own ego for instance and again nothing is done? because whatever, once you loose trust whatever strategy etc is recommended it will not succeed. This is people unnecessarily dying that we are talking about - someone's loved ones not an admin procedure or talking with one another.
Who has got the ----- to put it right?

#546015 Barrie Smith
retired
Health Care

Until workers can legally report shortcomings in an organisation endangering patients lives without risking their future employment , no patient is safe . The GMC is in the hands of the Old boy network and the Freemasons , there is no place for Secret Societies in the Medical and Legal Professions , this leaves the door wide open for complicity and cover ups .

#546113 pamela ellis
retired
daughter and on my own

I am desperate for someone to help me. Why can a hospital deliberately kill an elderly person. Lie to family. Coverup. Secret away truth in Freedom of Information. The Ombudsman whitewash events and not want to establish truth. The Government say they have to be impartial to nhs and the neglect of the elderly. I have spent 4 years trying to establish the truth and get answers to the admitted "neglect from the outset" shown to my mother. Only contempt to family when their criminal deeds have been found out. How is it if the CIO knows of irregularities they do not investigate? How is it the Coroner's Post Mortem Report does not reflect what really happened to the deceased. How is it family can identify they have been given 4 reasons of death and no truth. Are the Government and Hospitals in collusion to kill our elderly in secret and pretend their death is natural. Get away with co verup and lies when family prove otherwise. My mother suffered hell at nights,I was completely unaware of this. My mother was not given any treatment. I was unaware of this. My mother's admission reasons ignored, I was not aware of this. I am dying of grief - no answers. I wanted to bring mum home. NO. I read in a record after death "desperate to go home!. All my mother got was torture and death in their hands. I feel she entered a death camp.

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