Rob Webster: Can social care survive on the breadline?


Rob Webster

Following the launch of our report, Social care for older people: home truths, Rob Webster, Chief Executive of South West Yorkshire Partnership NHS Foundation Trust, discusses the impact of pressures in social care on the NHS.

This was recorded at our breakfast event on 15 September 2016.


So I thought I would start with a couple of stories really, on the back of the discussion we have been having. So I have been in the NHS for about 26 years, and I have had the pleasure of running community services, and integrated services with social care.  So in Leeds, looking at truly integrated health and care services with community matrons, and social care staff, it was great when the community matrons told me stories about being able to place somebody with their housing needs in 20 minutes, because they were in the same team, with the same processes.  And I think there are examples like that all over the place, which we have got to try and grasp.  But it is also the case that I talked to one of the district nurses that I know yesterday and said, “How are things?  I am doing this today, what kind of a day have you had?”  And she said, “Oh well one of the team went off to support another team in a different part of the system, because one of the palliative patients didn’t have any carers.  So all the care needs, and all the health needs at the end of life were being met by the district nursing team” which in a way I think is the way our staff get on with it and do the work, but is a sign of a system which is under stress, and not joined up sufficiently.

So I volunteered I think to be the chief exec lead for the sustainability and transformation plan in West Yorkshire. So what that doesn’t mean is that I am in charge.  I am not running a health authority, I am not in charge, I don’t have the authority to tell everyone else what to do.  What I am doing is leading a network of chief executives to say if we want to deliver sustainable services in West Yorkshire, what are we going to do together?  Now it is probably worth saying a few things about that, because it is really important.  The basis of that are some principles, and the principles we have agreed together are that we will be ambitious for the people that we serve, that we will be working together on this, this is for commissioners and providers, local government and the NHS, it is not a minority sport for one bit of the system.  We will do the work once, using the governance that exists already where we can.  We will have a shared analysis of the issues, and subsidiarity applies.  So you do the work where it’s needed.  So most of the work gets done locally, in Harrogate, Bradford, Leeds, Calderdale, Kirklees and Wakefield, and then some things get done on a bigger footprint.

Now looking at that ambition and what we want to achieve, and the analysis, it is pretty clear that 66% of people in receipt of carers are satisfied with the care they receive which is higher than the national average, and not bad, but a third of people are dissatisfied. Less than 50% of older people are happy with the level of social contact that they get.  So we have got a lot of lonely vulnerable isolated people.  We have quite a big care sector, so 650 care homes, 319 domiciliary care providers, and they are working in a system where if we continue to deliver health and care in the way we do today, by 2020 we will be about £980 million short of the money that we would need.  So resources are growing, we are investing in services, that’s clear, but we have to change the way we deliver care, everybody knows that.  And about 20% of that gap is in local government for public health and social care.

We do think about all three gaps that we want to deliver in the STP, so we are thinking about health improvements, we are thinking about care and care quality and variation, and we are thinking about the financial gap, and we are not only driven by the finances. And if you look at the ambition that we set out for services in West Yorkshire, I think it is quite a simple narrative, and one that is probably familiar to everybody in the room from where they are working.  So what we say is, you know in West Yorkshire every place should be a healthy place, which is child friendly and where you age well.  If you have got a long term condition, you are supported to self care, with peer support, community assets and using technology.  If you are frail or old or have multi morbidities, there is a team in communities which will support you.  You will be in the team, your carers will be in the team, third sector will be in the team, social care will be in the team, general practice will be in the team, which requires a new model of general practice based around clusters of at least 50,000 population with access to health, social care and mental healthcare facilities.

Those services will come together in populations which will increasingly be about accountable care, keeping people in a planned state of care on CCG style footprints. Hospitals will work in groups to be sustainable, viable, clinically and financially.  They will support centres of excellence, where there will be a smaller number, but the care will be world class.  All of that will be commissioned once and strategically, and there will be great engagement with the public to learn about why this is better than what we have got now.  So that is the ambition.  There is just the little matter of getting there.  And we haven’t got a complete plan yet, we are not expected to have a complete plan yet.  What we have is a shared ambition, a shared analysis, and a commitment to getting there.  What this report highlights I think is we have got to start looking at things through the right end of the telescope.  We have got to start with people, communities and lives, and not what happens at the other end of the telescope which is when we get that wrong, and we allow people to suffer behind closed doors for too long, and they become sick, and they end up in hospital, and the consequence of that, and they can’t get out of hospital.  Yes we have to sort that out, but we only sort that out by thinking about what happens in communities and people’s homes.

So what this report does very well I think, to steal a phrase from Stephen Dorrell who I know is in the room, it highlights that cuts to social care, not just bad social policy, but it is bad economic policy as well. If we continue with the services in West Yorkshire the way we are today, those delayed transfers of care we think will cost about 50% more than they do today.  So the report is a welcome contribution to the future, I look forward to seeing what the response is, it helps us I think in getting our plans together, so we have a chance of having sustainable services for the people that we care for.

Thank you.

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