David Oliver: Social care crisis needs meaningful solutions, not tinkering and soundbitesBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j436 (Published 27 January 2017) Cite this as: BMJ 2017;356:j436
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David Oliver's diagnosis is one that it is difficult to argue with, and the folly of hypothecated local taxation for care a point well made. But I have no great sense of confidence that integration of care into health will work. The health service has always been an unwieldy beast and is just too big for effective coordinated management. Similarly local authorities genuinely keen to promote independence, social inclusion, etc, etc, desperately want to do more in the community to promote well being. However with (in broad terms) 80% of the social care budget consumed by care home fees a population increasingly driven by long term illness rather than fecklessness or recklessness.
As trials continue to disappoint regarding disease modification, let alone prevention of cure of dementias and other progressive dwindling conditions, the scale and importance of care homes in the landscape of health and care is simply too great to be a bolt on for primary, secondary or social care in the name of integration.
What we need is not grandiose reshuffling of the deck chairs but some real initiatives to recognise the changed landscape.
So here goes! Care Homes and their operational practices and processes should be managed by a new department. No current health or care organisation has the capability of running beds at the cost base anywhere near that necessary to be viable as a care home operator. Current research should inform and over time refine the use of professional resources in care homes. That means defining the medical role, the nursing role skill sets and accredited training and career structures for care staff and managers. All these will suck cost out pf providers who can concentrate on quality differentiation.
Commissioning needs a national template. Most older people confronting a need for care are at a stage in life where sanctuary and compassionate care are more attractive than personal contracts (more cost saving) and processes such as assessment of needs. Care planning should be to a national standard which will promote further efficiencies and time to commit to personalisation and relationship based care.
By doing this neither the sovereignty of primary care or local authorities should be undermined. It also promises a basis for more intelligent discussion of funding.
Competing interests: No competing interests