For many years and under many governments the UK has puzzled over the relationship between social care and the NHS. All governments would like a seamless transition from the one to the other for patients who need both. All have looked at whether some administrative or management reform would make all the difference. No-one so far has come up with a perfect solution.
Some now say the answer is to put social care under the control of the NHS. Others say the local NHS in each area needs to work more closely alongside the Council’s social service department. There are concerns that the boundaries do not work well, with some Councils not moving quickly enough to provide social care placing greater strains on hospitals with elderly patients.
It is tempting to think we could reorganise to remove any boundaries between different public bodies providing services. Then maybe the unified budgets would lead to more optimal outcomes for both patient and taxpayer. However, it is difficult to see how you can avoid a boundary. If you put social care into the NHS you just shift the boundary to the one with Council provided care homes and sheltered housing. If you transferred local NHS control to Councils you would find it much more difficult to get benefits from national NHS policies, purchasing power and hospital planning. There would be a bigger tension between national and local NHS, with all the money coming from the national level.
As someone who has thought a lot about this problem as a former government adviser and someone helping with past Manifestoes there is no easy answer. I conclude it is best to start from what we have, and build in incentives and requirements for good conduct by both the NHS and local social care.What we want is a wide range of provision, with choice and capacity available for each different and often difficult case.
Someone in social care needs access to a good GP and or to a hospital Consultant for a worrying condition. Admission to hospital when needed is not normally a problem. Decent supervision of an elderly person should enable better management of any medical condition without emergencies or alarms in many cases.
Discharging an elderly person from hospital requires appraisal of their needs and prompt and helpful action by social services, housing and other relevant departments. This is where local accountability and Councillor supervision should wish to shine.
Promoted by Fraser McFarland on behalf of John Redwood, both at 30 Rose Street Wokingham RG40 1XU
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