|
On the May 2nd last year the Casey review of social care was launched, to…
‘… address immediate challenges in the sector.’
If you see the word ‘immediate’ you’d be forgiven for believing Ms Casey was to go about her work with some dispatch.
Here we are, 269 days later and as far as I can see, or know, or hear… zilcho is happening.
Sorting social care matters… now, but how?
Let's start with my five rules of health and care policies…
They must be;
- brief,
- personal; for staff and system users,
- clear,
- reflect the reality and
- practical.
Try this for size Ms Casey…
-
Brief: Whole Person Care.
One system, one journey.
-
Personal: Shared Governance.
The golden-triangle of professionals, communities and families, who, in real partnership, know what’s what, what needs to be done, by whom and when.
-
Clear: Place-based Empowerment.
Allowing local teams with shared budgets and shared outcomes… to get on with it.
- Reality: Social Determinants.
Management rule-book, page one…treat causes, not symptoms.
- Practical: Long-Term Stability.
Funding that enables strategy not firefighting.
The last one is important because; nothing happens until you can pay for it and it's not the problem you might think.
Moving to integrated, community-aligned and determinant-aware care is not preferable… it’s essential, but…
… Streeting can’t do big decisions. So it’s parked, buried in the long-grass, to just before the next election.
The evidence of this winter, with the best planning I’ve seen in years, tells us; pressure isn’t waiting. Neither should we.
The difficulty is not reluctance to collaborate, but ... working-together translates into transferring-cost, risk and debt.
One organisation’s solution becomes another’s liability.
Integration turns into pass-the-parcel… and when the music stops, it is usually social-care left holding yer-granny.
We could deal with this, now. No ‘Casey’ made case is required.
We have the Better Care Fund.
In June 2013 (the Integration Transformation Fund) later the BCF, was launched by the coalition government.
A deliberate attempt to break organisational silos… to allow money to move to where it could prevent harm, reduce hospital use and support need, earlier.
It signalled a shift from institutional protection to shared responsibility.
It allows NHS money to be spent on social-care and social-care money to support health outcomes.
Acknowledging the principle, that money should follow people, not institutions.
The BCF was meant to simplify integration. In reality it turned into a tangle of rigid rules, multiple earmarked streams, heavy reporting and limited local discretion…
… so opaque that nobody really knows how much is involved, even though it remains central to funding health-related social care.
Over time the BCF has narrowed, specified and policed to the point where discretion has been replaced by compliance... probably because HMT can't do flexible.
What began as a flexibility-mechanism now functions as a reporting framework. Managed upwards rather than used locally. Instead of enabling local decisions, it constrains them.
If we want progress now, within existing frameworks, the answer is greater freedom for the BCF…
… loosening national conditions. Trusting local systems to contribute to and deploy BCF resources where they will make the biggest difference to flow, stability, prevention, and…
… those decisions will look different from place to place.
Allowing health money to be spent unapologetically as social-care support, and social-care funding to be used to prevent health crises.
This matters because most of the system’s friction sits in predictable places…
- admission avoidance,
- discharge delays,
- step-down care and
- support for people with complex needs.
These are precisely the areas where rigid funding rules do the most damage.
When every solution creates a financial loser, collaboration becomes an act of bravery rather than good management.
Freeing up the BCF, letting local people decide how much they lob-into-the-pot, would not solve the social care funding crisis, but…
… it would change behaviour. It would allow local partners to agree shared priorities. Share risk openly.
This is not an argument for abandoning accountability. It’s an argument for shifting it, to...
... judging systems on outcomes, flow, stability, reduced crisis-demand…
... not on whether spending fits neatly into organisational categories that no longer reflect reality.
The wider reform debate will come. It must, but…
… we should not pretend that nothing can be done until then. The tools exist.
What’s missing is the confidence to let-go, at a time when Streeting wants to run the NHS from his desk in Whitehall.
Integration will not fail because we lacked structures or plans. It will fail if we continue to treat flexibility as a risk, rather than a necessity.
One system. One purpose, and…
… a Better Care Fund that finally does what it says on the tin.
| 
