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Part of Commission on the Future of Health and Social Care in England
Comments
It is embarrassing to think how often integration has been talked about and half attempted with a few well meaning experiments but nothing really changes.
There again I guess as long as more and more reports are allowed to be contemplated without someone really grasping the nettle and do what managers are paid to do - manage and manage well, the hope must be that all will go away if heads are kept low enough for long enough.
People do not generally work well together. There are many divisions between teams, contracts, CCGs, County boundaries, age groups (child/adult). Just joining Health and Social Care won't address any of this. People tend to work in 'tribes' so the effort need to go into making people work together better and focussing on the needs of the individual rather than the needs of the tribe.
The real cause of the issue is a lack of Government funding. This is causing us all acting like turkeys voting for Christmas trying to treat the symptoms and not this cause.
The population is getting older, whoopee what a surprise. Most people have paid all their working lives for their health and support and it should be no surprise that costs will increase but much of the money for this has been received, in proportion to the demand, over the lives of it's citizens this is not just money coming from the public purse.
We now have a system where, due to failures caused in part by a lack of funding, resulting rationing of services is doing great damage. This is exactly what the Government wants so they can justify increased use of the Private sector and all the lovely profit.
Other problems that need to be addressed include free movement of people within the EU which means many EU citizens can now move to the UK having paid no taxes and obtain free care and support. You need to be campaigning for the EU to provide the UK with substantial funding if we are to be expected to be the EU's health and social care service.
Good public services can be cheaper and better than private ones, the motive in providing these services must always be to deliver the best result for the patient/client and the tax payer. I do not believe that you can do this when profit is the primary driving force.
I admire much of the work that you do but this report could well have been written by a Conservative right wing think tank. Please think carefully about what you are suggesting. Providing the best services possible should be what drives us all, if we are pretending that we cannot afford essential, reasonable and appropriate services for our citizens because some politician says we cannot afford it then we are all wasting our time.
They can afford plenty of other nice to haves but they can't look after their own people. Very sad isn't it?
In many areas the working of both health and social services over lap, but in some instances each are still progresses this work separately, this creates duplication of work and is not cost effective as each service is paying for the same work to be undertaken. If pure joint working was followed with a pooling of financial resourses as well as staffing and other resources, this would result in a reduction of the unit costs.
However, this will not be easy to achieve, as both health and social services have their own ways of working, certainly on the administrative systems they use.
As to the concept of fundamentally changing the funding of health to reduce the areas of free at point of delivery. It is being considered to bring in charges for attending GP surgeries, but there will have to be exemptions and who would be within these exemptions. How will it be administered, as the GPs and others have already stated that they would not be able to do this, as was their reaction when there was the suggestion of enforcing charges at GP surgeries, hospitals and other areas for persons who are not supposed to be within the current free at point of delivery. It is well known that in many instances persons who are not UK and EU citizens have not paid for their treatments from UK hospials, even thoulg they may have been invoiced. There appears to be no facility to chase payments or a complete unwillingness to do so.
If charging is to be seriously considered then what would be the outcome impact assessments, would the charging not only dissuade persons who could be seen to be misusing the services, but in fact stop some who delay contacting services resulting in increased costs when their conditions deteriorate to serious or terminal.
The other factor when charging is introduced is that the initial charge will not remain as UK governments will increase the charge to supplement other revenues.
Currently many families are being hit by many increases in costs and reductions in service and the more services you use the greater impact these increases and reduction will have on these families.
There is in fact a large section of the community who while saving much costs to the UK or not effectively recognised by the authorities, although they are mentioned frequently by them. These are the family carers who care for their relatives for no monetry allowance. There is the Carers Allowance, but when you factor in the hours of care they provide, the allowance is effectively less than a quarter of the minimum wage. Then when the family carer is on retirement benefit this allowance is no longer paid.
To bring in charges would be, certainly another tax on the persons of limited income, whose income is currently being eroded by other financial increases they are bearing. But they will not only be the ones to suffer financially, for there are those persons, who currently can manage financially, but any new charges will mean they will not be able to do so.
So what is the answer, do we ration the services or withdraw them from persons who do not seem to be helping themselves. Do we only charge the super rich. Or do we charge all and then deal with the consequences.
Very few community benefits can be achieved through a single agency, collaborations are essential, health is no exception. These can be complex but the secret to their success is recognizing the complexity and adopting simple rules, as outlined in Validating Strategies by Phil Driver, OpenStrategies.
The OpenStrategies approach recognizes that ‘anyone can design a complicated strategy system but a good designer will develop a simple one’. The resulting OpenStrategies’ system is compellingly simple yet powerful, even for very complex, large scale strategies. Crucially, OpenStrategies doesn’t just underpin the design of strategies – it also guides their validation and implementation.
PRUB it or BURP it! OpenStrategies gives you a validated strategy (BURP) with a rationale AND an Action Plan (PRUB).
The OpenStrategies approach can be explored at the Validating Strategies website http://openstrategies.com/ and through the book: Validating Strategies - Linking Projects and Results to Uses and Benefits, published by Gower http://www.gowerpublishing.com/isbn/9781472427816. The book launch and seminar is to be held in London, on the 15th April 2014, hosted by OPM.
Additional publications can be found:
A) Written evidence Public Administration Select Committee (PASC): Building Civil Service Skills for the Future (aka. Civil Service Skills)
1. UK Parliament: PASC web link http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-administration-select-committee/inquiries/parliament-2010/civil-service-skills1/
for the evidence go to the GREEN box at the bottom of the page and select ‘Written Evidence’, then GO
2. To download the evidence, ref: CSS0002, http://data.parliament.uk/writtenevidence/WrittenEvidence.svc/EvidencePdf/6973
B) Challenge on the Standards Hub, sponsored by GDS the Cabinet Office, the Governments Digital Service (GDS),
http://standards.data.gov.uk/challenge/open-strategising-achieve-benefits
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