ReportPaying for social care: Beyond Dilnot
Paying for social care: Beyond Dilnot discusses the history of social care reform and considers the present and future funding pressures on the system. The paper calls for health and social care services to be considered as a single system with a new framework being put in place for planning and cost-sharing.
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Please do not make statement about healthcare, changes and doctors if you are not a doctor like me who has worked with very sick children in hospitals and community in the last 30 years.
It may be very difficult for you to understand what I am talking about too if you are not a doctor. You will hear about me in July or get to see all the documents I have to help prove my point
There are pockets of good work and plenty of initiatives, yet there are also strong conservative, resistant, and negative forces which militate against such good work.
Dr. Kadiyali's comments have an intensity that send a chill through the spine of anyone working genuinely in the sector and it seems we are yet to hear further in July as the story unfolds.
Successive Acts and policies over at least the 40 years of my experience have required health and social care to work together. Some places manage to do this really well, most muddle through, a few are desperately bad.
Why not put the total responsibility for all these services into the NHS?
This is the time to ask the impossible questions, what have we got to lose? Failing to ask the impossible questions will just get us more of the same, from a smaller budget - no thank you!
I would urge your panel to read the valedictory lecture given by Sir Alan Langlands to the Nuffield Trust reflecting on his time in office: you could substitute 'social care' for 'education'.
Soon it will be time to consider that the NHS is now the greatest impediment to a good future health service for this country whilst recognising that the people struggling within it are our greatest asset?
i am not sure i buy this. The kings fund has frequently criticised government policy. The review "health policy under the coalition government" or the "never again" book are highly critical, as is my recent blog on "managing expectations in healthcare" (though i am equally critical of management consultants and private healthcare providers). Nick Goodwin before he left the fund clearly shared my impatience with the telecare/telehealth infomercial (see by the way today's latest null trial of WSD in "age and ageing"). With regard to dignified care for older people, the Age UK/NHS confed "delivering dignity" commission or the kings funds own "care of older people with complex needs" report made very clear criticisms of organisational leaders and leaders of professional organisations such as RCGP/BMA etc are often more than happy to be combative and outspoken. I do believe we have a current "great and good" which is a combination of NAPC/NHS Alliance/management consultants/private health providers and their lobbyists/some former ministers who are pushing a "new orthodoxy" around plurality, private provision, care outside hospital, telehealth/telecare which flies in the face of what is actually happening in frontline services and emergency care. But even here, the fund have challenged the prevailing view. So who are "the great and the good"? I am not sure i know
David
To what interest our minority perspective may provide;
For those traditionally left substantially out by both health and social care, the future surely has at least as much potential inclusion as the past has had exclusions.
However, it seems that the time is right now. Groups like ours are working to ensure that, whilst inevitably we are still on the margins, we can perhaps also be at the cutting edge. If whatever change the future holds, in terms of integration and a shift to 'community based' rather than institutionally based care, can be made to work for most traditionally excluded groups at the outset, it will most likely be relatively easy to adjust to for the 'usually included'. But, if the 'usually included' take full control of the cutting edge, they will use it to eat all the pie as, one might say, usual.
Regards all
If this Commission could clarify the roles (and training ) of those offering nursing and care with a clarity of language about what care assistants assist with, what live-in carers, family carers and care homes should be able to cope with and what they need help with (possibly from a new specialist group that the current nursing profession does not provide for) it will make a good start. Then we might be able to look at the design of a Home Health Service which understands the challenges it has to meet.
The Commission could also look at the need for specialist training in dementia nursing which does not appear to exist yet. For nurses (or even carers) to be able to to assess the decline in the swallow reflex as stroke and dementia patients near the end of life it would help with the timing of the introduction of thickened diets and the avoidance of aspiration induced pneumonia.
With hospices generally not wanting to be filled with dementia patients, an end of life pathway for them may be an appropriate issue for the Commission to address as well. At its foundation the NHS was designed to treat disease and cottage hospitals as places to die in were regarded as redundant - and therefore closed. In looking at the interface of health and social care the enabling of 'good deaths' must be planned for rather than ensuring 'bad deaths' by default.
david oliver
"whilst there is a need to address the joining up of H&SC, why not tackle the complete bureaucracy, incompetence and duplication of effort in our hospitals, free up the cash and then address the joining up of services!"
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