I’ve seen country churches with more people in the pews, on a Sunday…
… than there were on the green benches, yesterday, when health and social care minister, Edward Agar, made a statement to the House introducing the long-awaited, health and social care integration, white-paper.
‘Agar’, in another world, is a mixture of two components, the linear polysaccharide agarose and a heterogeneous mixture of smaller molecules called agaropectin. Bringing them together forms the supporting structure in the cell walls of some algae and is released on boiling.
So, our Edward, you’d think, was ideally placed to tell us about bringing together two, seemingly immiscible, substances to make better the supporting structure of health and care.
Alas, it looked like steady-Eddy was all too steady. Certainly getting nowhere near boiling point. He didn’t appear to warm to his topic.
Did he want to get off to watch the winter Olympics? Was he just bored with the subject? Perhaps he’s tired? I would not suggest, for one moment he’d had a late night at a party… he’s not the type.
Perhaps it’s just too much for him?
The complexity of services, the almost incomprehensible size of the budgets and the pull of the centre against the push of what happens on the ground may have him befuddled.
Getting the NHS and social services to work closer together has become the health and care Holy Grail.
A career-maker for whoever pulls it off. If it’s too much for Steady-Eddy, it’s a shame, because it is worth doing and the blueprint, if he did but know it, is there for the taking.
He should go to Morecambe Bay and take a look at Bay-Health… that’s the way to do it and what happens when you get out of the way.
The Paper avoids the obvious solution; move social care into health, or if you want to get complicated, move health into social care. Either way, the problem is, health is free at the point of use and social care is means-tested.
Immiscible, Eddy?
If you think about it, all we really need to do is three things;
- Find a way for health and care to share budgets,
- access each other’s data
- and create incentives for the two to play nicely together…
… and on the way, make the health service more locally accountable.
It’s not like we don’t know how to do it;
- Section 75 NHS Act 2006 sorts-out pooling money,
- Matthew Gould fixed data sharing during Covid, ask him
- and banging heads together with money will do the rest…
… ICS’ set-up right, will sort accountability.
And there is a plus; the White Paper acknowledges, the wrecking-ball of Covid demolished many service boundaries.
A lot of people just went and did what worked. They integrated…
… it’s what comes naturally when you ask people to work together and get out of the way.
This White Paper is an easy read. Avoid the blah-blah, start with pages 8-13. It describes a Gordian Knot of services and like the Knot, only solvable by bold action.
Take the time to read it all if you can. It sets out what good could look like. That’s the only job of a White Paper and it does it well.
Is the ‘good’ achievable?
Yes, a lot of it is being done. The Paper invites a conversation about how we can make, outcome-based, local care for vulnerable people, whose needs straddle the landscape of care and health, routine.
Workforce issues, interface problems, governance details, data complications and the risk the CQC will trample all over it. Buy-in from local government, confidence-building and accountability…
…are either stumbling blocks or stepping stones.
We’ve waited a long time for this document. It creates opportunity, has new ideas (I do like the skills passport) and invites us to show our good stuff, learn from each other and make it happen.
This is a chance to bring the future a bit closer and I’m quite excited. Pity about Eddy.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
