Integration of Health and Social Care

Baroness Murphy

Dr Clare Gerada

Baroness Cumberlege

Lord Laming

This morning I chaired the last of four seminars for peers about the new draft Social Care Bill. They’ve been organised by Baroness Jolly from the Lib Dems. The last seminar this year but not the last of the many more I expect for next year when the bill finally arrives. The topic today was the integration of Health and Social Care. As long as I can remember these divergent services have been cajoled, bullied, encouraged and exhorted to work together. In most places they never have. From the patient’s point of view the lack of coordination between the NHS and those that provide personal and domestic care has been incomprehensible, but as long as the organisations responsible come under different management systems and different funding regimes split by the ideologies of central and local government, nothing much will change. I was hoping personal care budgets held by the individual would help but so far they have hardly taken off. Neither the last Health and Social Care Bill nor the current draft social care bill has any real hard incentives to change the status quo. There are areas where they have managed to bury their differences in the interests of patients and their families and many places pride themselves on a joint planning system. But Dr Clare Gerada from the Royal College of GPs thought the situation was getting worse in some areas. There was some debate about whether GPs were trained to work with other disciplines or not at the moment. Lady Cumberlege’s experience suggested perhaps not. I do not see GPs rushing to become co-ordinators of care and like Lord Laming I am not convinced that it would be the right direction to take. The difficulty is that someone’s got to manage across the system and right now no-one does.

But until staff in both services take to heart the fact that people with long-term conditions usually need more social care than health care and that all people in receipt of social care have an illness or disability, I suspect matters will go on as they are, endlessly wasting resources in the Health Service and starving social care of funds. The Government has a responsibility to provide the right incentives but since 1948 successive administrations have continued to sidestep the issue.


6 comments for “Integration of Health and Social Care

  1. Rhodri Mawr
    06/11/2012 at 7:25 pm

    Curiously enough whilst eh noble Baroness was writing out her blog post, i was asking exactly the same question of two ladies locally with whom I was godsipping, in this case perhaps the noble baroness’ committee, the god.

    I am told by both locally that the care in the home only lasts for six weeks and even some of that has to be paid for.

    If care in the home is to be an economic substitute for care in state funded or owned homes, then it has got to be far more than six weeks for a person of 89.

    Certainly doctors would not want to be involved in yet more drudge. Is it not a local government economy that we are talking about? There is always scope for that, and lesser paid employees to do the paper work, with some enjoyment of a job well done for them too.

    It sounds as thought the magic six weeks these ladies quoted to me should be increased to 12. Who would be footing the bill for that. It is car, and labour consuming work, but still much cheaper than
    nursing/residential homes.

    When I first started in local government (Worcester city) I visited one home which had 80 old folk in it all sitting round in armchairs with nothing to do, although some managed to spend a few pence at the betting shop every week!

  2. Gareth Howell
    06/11/2012 at 7:28 pm

    I was hoping personal care budgets held by the individual would help

    Like educational vouchers that were tried and quietly dropped.

    Personal care vouchers might do quite well.

  3. MilesJSD
    07/11/2012 at 6:22 pm

    To “put-away”, or to “put down”, and who “calls the shots ?”

    It all depends on Definition,
    by fallible words,
    [which should be (but are not) supported by real-life Illustration, multi-dimensionally recorded, of real-life subject-scenarios (film, video, dvd)]
    1) “Health” “Unwellness” “Illness” “Disease” “Wellbeing” “Behaviour (versus) Conduct” “Training (versus both Education and ‘Re-education’) “Treatment” “Management” “Normal” “Bizarre” “Right-Mindedness (versus) ‘Wrong’-mindedness” …
    (and so on and so forth, “ad nauseum”).

    How faithfully and sustain-worthily these terms are defined in Law and Regulation by (mere) words,
    but more essentially are practically, even enforceably, backed up by ‘real-lifeplace’ filmed experience & scenes, by (respectively) the ‘providers’ and the ‘victims’;
    and are ‘locked’ (‘entrenched’) into constitutional, legislative, and prescriptive/stipulative usage, enforcement. and practice
    and thereto, how faithfully have been recorded the multi-dimensional ‘live scenario’ evidences of each such ‘mental-health’ versus ‘mental-psychiatric-illness’ cum mental-health ‘issue’ or ‘problem’, scenario, qua “term”,
    will literally dictate both
    A. How true-to-life are the Governancial and Professional Institutions of today and of our longest-term Future, in their respective Workplaces; and
    B) How healthy we (all) are and shall be individually ‘on-the-ground’, and as an essential and sustain-worthy Nation intersupportably with the rest of the Human Race, in our respective Lifeplaces.

    2) But it should also depend upon how effectively we can work together to correct the Tower-of-Babel-like “Pay-&-Personal-Prowess-Pyramids” that are in almost runaway-ballooning;
    and how soon we can realise
    that being one-human-being but coercively-demanding many more livings than one from the Common Purse
    is NOT conducive to being either a believable Authority on living
    or a sustain-worthy Earth-citizen living within our Common Means.

  4. MilesJSD
    07/11/2012 at 7:14 pm

    We do not have a “Health-Building and Support Service”
    only a (recognisably focused, quick and good at-illnesses) NIS (National Illnesses Sector);

    Neither do we have any effective and supportive institution for Individual Health Maintenance and Building,
    nor for like-oriented Mutual Health Building;

    thus without individual-health-building we can not have any sufficient and effective “Social Care”.

    So we can not “integrate” a non-existent “Health” with a non-existent “Society”.
    One instance of the neglected and excluded progress, from The Feldenkrais Movement Institute (and Frank Wildman PhD.)
    ‘The Intelligent Body: Improving With Age’:

    “The older we get, the more clever we must become.
    We must improve our quality and ease of motion, our coordination, our sense of balance, control and comfort.
    However, there is little available in our culture to help us learn how to reduce stress while increasing muscular efficiency in a pleasurable and comfortable manner.”
    [(“) Because of this it has become ‘wrong’ for aging people to explore new ways of moving.
    But a programme for older adults to be guided into easier self-management and movement, involving being guided out of their own (and our Society’s accepted, even ‘Crosses-to-be-Carried’) unimprovable pains, rigidities, and movement limitations,
    resulted in stress-free, pleasurable and interesting ‘new’ movements, that were easy to do and
    most importantly
    changed the way they understood and used their bodies (“)].
    “With these fascinating and relaxing movement lessons I present to you an alternative to pain, stiffness, and restricted movement” (Dr Frank Wildman).
    How does this new integration, legislation, and regulation of Health and Social Care, and
    (see Baroness Murphy’s other blog on Mental-Illness Sectioning, Mental-Health)
    (consider wider the Generally Progressive Health of the Nation and of Whole Peoples worldwide)

    both recognise and facilitate our pursuit of such health advances as this “Improving With Age” one, instanced above ?

  5. ladytizzy
    08/11/2012 at 3:51 pm

    Baroness Murphy, have you been able to watch the excruciating Getting On (BBC Four, Wed)?

  6. Gareth Howell
    08/11/2012 at 4:59 pm

    Neither do we have any effective and supportive institution for Individual Health Maintenance and Building

    Leaving Feldenkrai out of it there is certainly no such organisation but why should there be? That said the plethora of “charities” for the support of syndromes which are not diseases at all, and in the 19thC would have ranked alongside/with Hysteria, do everything they can to promote disease. They are generally run by people who are thorughly ignorant of what the real problems are, keen to accept the Blah of GPs who need their continuing business

    Pathologists have a lot to answer for as well, and nothing!

    The study of statistics and its models, at the level of government, do little to encourage good health, a great deal to promote the complete possession of the individual by the state, whichever department it may be. Sickness, war, Indoctrination….. and so on.

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