The integration of health and social care services, as reportedly ordered by David Cameron, is the holy grail of public policy. More than a nice-to-have, it’s an absolute imperative if we are to maintain the 1948 welfare state settlement through the seismic demographic changes we are starting to undergo.
No one understands this better than the six million unpaid carers who every day have to negotiate the maddening demarcation lines between NHS services and social care provision funded – but these days rarely provided – by local councils. To secure and sustain a package of care and support for their spouse, parent, child or neighbour or friend, carers know that invariably they will have to deal with multiple agencies. For most people, their GP is the nearest thing to a one-stop care shop. But rare as hen’s teeth is the surgery that offers an on-site gateway to social care services as well as health. The best that many patients or carers can hope to emerge with is a telephone number to call.
Maddening, yes, but also ruinously expensive. The sheer duplication of effort and time involved in separate application, assessment and allocation systems within each service silo is crippling the state machine. And it can’t go on. Already 15 million people in England are living with one or more long-term conditions, such as diabetes, arthritis or depression. As the population ages, that number will rise fast. Belatedly, the NHS has come to realise that its principal customer is now and henceforth not a young adult with an episode of curable illness, nor even a child with a racing temperature, but a frail older person with a heart condition, emphysema – and probably dementia into the bargain.
Such customers have long been the staple of adult social care services. Bringing the two service streams together has always made sense theoretically; today it makes sense in blindingly obvious practical and financial terms. Imagine being able to trigger a single, rounded service from one source, at one time, with one application and one assessment. For carers, that would be a truly liberating experience that would free many more to work, study or just attend to their own lives. For a few, it’s an experience that is already a reality – or at least a near-reality – in a handful of places, such as Torbay and Herefordshire, that have pioneered forms of integrated working across health and social care.
But of course it’s not straightforward. If it was, it would already be the norm. Quite apart from fierce tribal rivalries between the NHS and local government, there is the fundamental problem that while healthcare is essentially free at the point of need, social care is means-tested. And the means test is now so punitive that, in much of the country, only a small and shrinking minority of people are eligible. For anyone with assets of more than £23,250 and/or needs deemed less than “substantial” or “critical”, the harsh truth is that they must pay for their own social care services. Councils are supposed to offer information and advice to people in such circumstances, but that all too often means merely provision of a list of agencies from which you are left to buy services.
We wait to see what Cameron’s “order” to integrate health and social care will mean on the ground. Based on past experience, many observers will be sceptical of a breakthrough. Based on their current experience – that is, being told their loved one is ineligible for social care – many carers will be asking what’s in it for them anyway.
http://www.guardian.co.uk/commentisfree/2012/
