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In 2021, the government pledged significant funding to develop the adult social care workforce in its People at the Heart of Care whitepaper. However, in 2023 the government confirmed that the proposed £500m, which was to be used to improve training and qualifications, and help people feel recognised and valued, has now been halved.
Funding is always going to be a challenge within the health and care system, and it could be argued that no amount of money will resolve the deep-rooted problems that exist in how health and social care work together, including interactions between local governments and private sector partners, to improve the lives of citizens.
For individuals and populations there are many wider determinants of health that are influenced by social, economic and environmental factors, such as a person’s housing conditions, their social interactions or their opportunities for work. In fact, estimates suggest that 80% of health outcomes are determined by these non-health related inputs.
As the custodian of ‘place’, and by statutory duty, many of these areas fall within the remit of local government. Whilst the link between social care and health is incontrovertible, the role of local authorities in relation to housing, education, planning, air quality and green spaces is not always fully understood within the NHS.
Could the shift in funding present an opportunity to reconsider the healthcare and social care model, enabling greater collaboration across all sectors? In her book, ‘Whose health is it, anyway?’ the former UK Chief Medical Officer, Dame Sally Davies argues, if we continue to build our policy and healthcare model based on managing ‘illness’, costs will spiral and the population of the UK will be continually cursed with a longer life being lived in poorer health. She calls for a shift to ‘Total Health’ which includes physical, mental, and social health, and also the underlying drivers that influence them.
However, achieving ‘better health’ and reducing illness is a significant challenge due to health and social services being fragmented, siloed and ‘atomised’. This inevitably means that effort is focused on organisations, structures, roles, and finances, and not citizens’ needs or the skills and competencies to meet those needs. This is, to be blunt, too slow.
Partnership precedes integration
The government has recognised the importance of greater integration of health and social care with its plan for Integrated Care Systems (ICS). It acknowledges that the best outcomes are achieved when organisations collaborate; “One of the lessons learned from the Covid-19 pandemic is the value of local councils, the NHS and voluntary and community organisations working together to provide joined up care and support.”
ICSs may be a viable long-term solution, but it will take time to see the benefits of these new collaborations and it is still uncertain whether the different parties involved will be able to integrate successfully without further systematic and structural changes. Partnerships with private organisations can help enable meaningful integration as they often have the expertise to deliver across a range of service areas, such as health, welfare and local government. This rounded view is needed to ensure partners are capable of understanding the bigger picture and analysing how care is being provided from different angles. By understanding the needs of citizens, the issues of workforce capacity and capabilities, the population they serve and the patient experience, partners can bring a new perspective and tailor solutions that can enable greater collaboration and integration, and crucially improve important health outcomes for citizens.
An understanding of the long-term cycles in the health and social care system is needed to build the competencies to improve the outcomes of healthy life expectancy and reducing illness. This combined approach of looking at illness and opportunities to improve health has been taken by the Department of Work and Pensions (DWP) with its Mid-life MOT, a review for workers in their 40s and 50s that helps them take stock of their finances, skills and health, and enables them to better prepare for their retirement and build financial resilience. As well as encouraging individuals to take personal responsibility for their retirement planning, the scheme is also being delivered in the private sector through employers and through the DWPs network of jobcentres. This kind of government and private sector partnership shows that not all challenges can be addressed within the public sector alone and there’s significant benefit to be gained by working with private sector partners.
From procurement to virtual care – what can be done today?
The health and social care yearly budget is more than £180 billion a year and the total procurement budget spent on drugs, services and supplies is circa £60 billion per year. Transforming procurement can bring significant savings. For example, we set up a single procurement service and operating model across eight NHS Trusts, which reduced the overall cost of procurement by £46m.
By December 2023, ICSs were asked to deliver virtual ward capacity (where patients receive care at home) that was equivalent to 40 to 50 virtual ‘beds’ per 100,000 population. Virtual wards will require health and social care services to be integrated, and we are working to support NHS teams by bringing together design, mobilisation, operational delivery, and clinical governance services. These components can help realise the potential of virtual care for preventing hospital admissions and providing proactive support. As virtual wards are inevitably expanding to offer support for a broader range of care virtually, they will also facilitate new initiatives in care coordination and streamline access to services. By improving clinical outcomes and operational efficiency, virtual care can help break the cycle of crises.
Addressing the workforce challenges within health and social care and achieving the aims of integrated care could take a decade. Yet, greater collaboration with partners beyond the immediate ecosystem can help to relieve the pressure now.
This article was first published in the Health Service Journal