There was probably never a better time than now to revisit the bizarre scene at the end of the Life of Brian, and the advice from the Monty Python team to `always look on the bright side of life’.
It would be overegging the pudding to say that adult social care is in the same fearsome predicament as John Cleese and Eric Idle were at the tuneful end of that film. But if it seems to directors that our equivalent is to walk three paces backwards for every step forward, then who could blame us for thinking so?
Amid serious issues about the best way we can accommodate our services to the government’s CSR over the coming four years, and the inevitable succession of hard decisions each director will be making in the coming three months or so, two short paces forward were registered last week.
First was the publication of the government’s Health and Social Care Bill. The inevitable focus of much of the discussion so far has rightly been on the scrapping of the PCTs and the creation of GP consortia. The jury will be out on that for a good time. The least said soonest mended, but PCTs, however well-managed individual trusts were, never really captured either the imagination of the public, or the commitment of other professionals within the health and social care sector. The arguments, however, about the restructuring of primary and community care services, and whether or not GPs are ready, willing and able to get a grip on them will last right up to the wire in both houses of parliament.
What is far more certain is the opportunities the Bill gives local authorities to exercise their duties of care to vulnerable adults and older people within the context of the health and wellbeing boards that, despite quite a bit of wavering, the government has finally decided to put on a statutory footing. It is the body where, over the coming years, a broader, more inclusive approach to communities’ good health (wellbeing and public health) and ill-health – and the vital links between them – will be forged. It is the theatre in which the final scenes of NHS/Social Care integration will at last be enacted.
Yes, there are still problems about how exactly public health is going to settle into the local government family. And that will be determined largely by the balance of funding and authority that exists between individual directors of public health and the new body, Public Health England. But all told these changes will prove to be a major step forward for adult social care.
The three steps back? Undoubtedly the squeeze on spending due to kick in in 2011/2012 will threaten the integrity of the moves if they are used as an excuse for not pushing as hard at these changes, and the personalisation changes, which are so much a part of our future. There will be a threat of institutional shock and awe while the changes in primary care management begin to bite. And thirdly, we must never forget the perils of disenchantment and demoralisation that could affect key staff during such difficult times.
Another step forward has been an open and honest discussion about a process which lies at the very heart of social care’s relationship with health: discharge from hospital. How can the arrangements be improved, and who is responsible for delays if they occur? The debate was given an almost surreal focus in a national newspaper recent survey of a small number of hospital doctors, with the views of an even smaller number providing the newspaper with its front page headline: `Care cuts leave elderly people stuck in hospital’ it shouted.
Careful investigation subsequently showed different. 'Situation report' figures for 2010 totally give the lie to the distorted account carried in the media. From August through to October last year 24 per cent of delayed transfers were attributable to social care; seven per cent were the joint responsibility of health and social care, and 69 per cent were generated within the NHS itself. Interestingly the pictures gets slightly murkier if you move out of the acute hospital sector and include community hospitals. Social care services are responsible for a higher number of delays there, but still nowhere near the NHS total.
The blame game having been played, let’s stop it there. The reality of `bed blocking’ is that it is a deeply complicated area with no easy answers to be had despite the simplified slant, heavily blaming local government, that the media have been peddling for years. They will have their own agenda, while ours brings us back to the Health and Social Care Bill. Nothing could better justify the impetus towards closer adult social care/NHS commissioning and integration than the challenge of delayed transfers. Indeed, delays always expose the quality of the stitchcraft of integration - the fewer delays there are, the less visible become the seams which join these twin pillars of wellbeing together.
In a way the arguments engendered by the newspaper actually served as a great reminder to the more sober heads in both health and social care services. Moving towards closer integration is an obligation we owe just about everybody – citizens, patients, care-users, self funders, carers, communities and families. Doing less is not an option, and if that message has emerged more clearly over the past week or so then… Well perhaps looking for the bright side of life isn’t such a bad idea after all.
Richard Jones is president of the Association of Directors of Adult Social Services
