Forward view
Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission.
The Five Year Forward View published on 23 October makes a compelling case for the sustained future of the NHS. There’s a lot of common sense set out in 39 fairly easy to read pages. My favourite passage is on page 28:
“…in particular, the tendency over many decades for government repeatedly to tinker with the number and functions of the health authority / primary care trust / clinical commissioning group tier of the NHS needs to stop. There is no ‘right’ answer as to how these functions are arranged — but there is a wrong answer, and that is to keep changing your mind.”
I know that many in social care have been frustrated by this constant change and how it undermines the relationships necessary for building trust so joint working is successful.
Social care perspective
There has been criticism from some quarters that the important role of social care did not get the attention it deserves in the Forward View. But social care does not get completely ignored and there’s more consideration than the normal afterthought of ‘and social care’ we often see in health-focused documents.
So with apologies to the Life of Brian scene “What have the Romans done for us?”, what does the Five Year Forward View do for social care?
- A strong commitment to shared budgets combining health and social care and breaking down barriers between health and social care.
- A recognition that cuts in local councils’ social care budgets have impacted on the NHS and if the NHS is to make the efficiency savings identified, social care services will need to be sustained.
- A promise that citizens will be able to access their medical and care records, including in social care contexts, based on the use of the NHS number in all settings, including social care.
- An undertaking that the NHS will provide more support for frail older people living in care homes by developing shared models of in-reach support, including medical reviews, medication reviews and rehab services.
Other proposals that will be welcomed by social care include:
- 1.4 million full-time unpaid carers to get new support.
- The NHS becoming a better partner with voluntary organisations and local communities.
Working together
I particularly welcome the move to provide better NHS support for older people living in care homes. This reflects work that CQC and others, including the British Geriatrics Society have done, highlighting that many people living with dementia living in care homes are not getting their health needs regularly assessed and met, which undermines quality of life and can lead to avoidable admissions to hospital.
There are some excellent examples of the NHS working well with social care. I visited the Care Home Support Team provided by Gloucestershire Care Services NHS Trust earlier in the year and was impressed by their commitment to support care home staff to provide the best quality of life to individual residents. But we also hear of care homes struggling to get support from primary and secondary health services so we need to make sure it’s the best practice that gets shared and strengthened.
Care Home Inquiry
For those of you wanting a greater focus on all things social care look no further than John Kennedy’s Care Home Inquiry published on Sunday 26 October. John speaks from a position of great experience as the Director of Care Services for the Joseph Rowntree Foundation. His inquiry over the last year took him beyond the JRF speaking to people using services, their carers, staff and managers across the country as well as commissioners, regulators, policy makers and politicians. It’s a very good piece of work.
John persuasively argues for “a clear vision for our future care, based on the reality of our human condition. Kindness and compassion need to be nurtured, it can’t be just legislated. The care home sector needs to be brought in from the cold: valued, supported and fully part of a co-ordinated system.” There is much to applaud in the report, starting as it does from a personal perspective that I thoroughly agree with:
“What I want [from a care home] is kind, confident, compassionate, skilled people looking after me. I want to have a human relationship with them. I want to feel safe. I want to feel valued and I want to have a bit of banter as well. I want something of them and their time and I want them to feel they can give it. I would also like to be able to give of myself too.”
Humanity in regulation
These concerns are at the heart of the five questions we will ask of all services — are they safe, caring, effective, responsive to people’s needs and are they well-led? The focus on humanity that John calls for is clear in the characteristics of good and outstanding services. A good caring service for example is where:
“People receive care and support from staff who know and understand their history, likes, preferences, needs, hopes and goals. The relationships between staff and people receiving support consistently demonstrate dignity and respect at all times. Staff know, understand and respond to each person’s diverse cultural, gender and spiritual needs in a caring and compassionate way.”
Or, an outstanding responsive service is where:
“The service is flexible and responsive to people’s individual needs and preferences, finding creative ways to enable people to live as full a life as possible. The arrangements for social activities, and where appropriate education and work, are innovative and meet people’s individual needs.”
Challenges
Of course there are challenges raised by the Forward View and John’s Care Home Inquiry. But as both documents make clear, the prize on offer is great and we need to work together to achieve it.
Originally published at www.cqc.org.uk.
