UK Social Care: Challenges Integrating Health and Social Care | In Practise

UK Social Care: Challenges Integrating Health and Social Care

Current Chief Executive of Care England

Learning outcomes

  • The role the government plays in organizing the health and social care system
  • Potential solutions to the challenge of UK Social Care
  • How to motivate low paid workers
  • A values-based recruitment process and techniques to keep employees engaged
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Executive Bio

Martin Green

Current Chief Executive of Care England

Martin Green, Chief Executive of Care England, the largest representative body for independent social care services in the UK. In 2012, in his role as Department of Health Independent Sector Dementia Champion, he led the development of the Dementia Care and Support Compact for The Prime Minister's Challenge on Dementia. He is also a member of the Secretary Of State for Health's Stakeholder Board; a Dignity Commissioner; a Lambeth Transformation Commissioner; A member of the Nursing and Care Quality Forum; a Board member of the National Institute for Health Research (School of Social Care) and a founder trustee of The National Skills Academy for Social Care. In 2008 he was awarded an OBE for Services to Social Care in the 2012 Queen's Birthday Honours List. Read more

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Could you explain your role at Care England?

Care England is the largest representative body for social care providers. We have about 3,500 different services in our membership, the majority of which are older people’s services. About a third are for older people living with learning disabilities, as well as some brain injury and mental health units. We cover the whole of the social care sector, particularly residential social care.

What have been the core challenges in the sector that have led to bankruptcies such as Southern Cross in 2011 and Four Seasons more recently?

The issue is about funding. There is no proper and coherent funding level. We’ve just published some research identifying that there are many authorities paying less than £500 a week for social care. This equates to about £2.97 an hour to provide accommodation, care, and support on a 24-hour basis for people with dementia and other health conditions. This is totally unsustainable, and it really shows why there are difficulties within the sector around funding. If it weren’t for the funders who fund their own care at true cost, the sector would be totally unviable.

The sector’s underfunded, and there have been reports of private payers subsidizing public payers because of this issue. How do you look at your social responsibility as private equity-backed, independent care operators in the UK?

The social responsibility lies with the government. We have to get the government to understand the true cost of care. I reject the criticism of people bringing money into this sector. If it wasn’t for external investment, there would be no new services whatsoever. There has been no provision by the government in new buildings or services for about 30 years. This is now a system reliant on private practise and organizations putting in investment.

You lay the blame strictly on the government?

Absolutely. It is the government’s fault.

What has been the source of the issue?

The government is in complete denial about the importance of social care. They obsess about the NHS. In the recent election campaign, we saw more and more commitments to give more and more money to the NHS. We’ll soon have a £200 billion NHS, and yet, it still claims to be underfunded and in crisis.

There is no proper approach to social care or maintaining people in communities. The inability of the government to deal with primary care means people are going to their A&E departments when they could be going to primary care, and the government should have a much broader approach to that. Care homes could be centers of support for people with long-term conditions in communities.

We have seen the government pouring money into the NHS but not recognizing that social care is inextricably linked to it. It’s particularly irritating when they constantly talk about “health and social care” and have renamed the department the Department of Health and Social Care. They talk endlessly about integration, but they’re not doing anything to ensure equity across the system.

Why are the two forms of care not integrated?

I think the problem is we have the NHS, which is the dominant focus of all political attention. What we’ve got to do is reclaim the term “integration.” Too often, integration is talked about in terms of the NHS social care local authorities, and those are not the important things. True integration is about the experience of the person who uses the service.

A good example: I get on a plane. I do not know when I leave Austrian airspace and go into German airspace. There is a huge administrative process going on in the background, but all I experience is a flight from A to B. That should be the Holy Grail of integration in our system. It shouldn’t matter who is providing the service, as long as it’s a seamless service for the person who needs it.

You think this is more of a political drive from the government, in focusing on the NHS rather than social care?

It’s a political drive, but it’s also supported by citizens who don’t understand the difference. Citizens who have no connection with it, I think they think a lot of these things are dealt with by the NHS and they will be free at the point of need. The reality is a lot of these issues are not free at the point of need and are not dealt with by the NHS. Despite the fact some of them like Alzheimer’s disease and dementias are health issues, the moment you become a long-term health issue, suddenly, the government wants to shift you out of the NHS and into social care, but they haven’t recognized that if they’re going to do that, they need to both fund it properly and engage with the general public so they understand the issues.

What role do the regulators play?

Regulators have an important role. I want to make it very clear; I do not want a system that is not regulated. Just as I would never get on a plane if it wasn’t a regulated service, I wouldn’t want to go into a social care service that wasn’t regulated. There are systemic issues with our current regulatory system, which relies too heavily on snapshots and regulating process, rather than whether people have a good experience of the service.

In future, we need to see regulators who rely far more on real-time data to assure quality. Also, we need to be really clear that the experience of the person is the outcome we’re trying to achieve. What we’ve got is a regulatory system that looks too much at the process rather than the outcome and the experience of the person. Regulators are under the same pressure providers are; if anything goes wrong, they tend to be hung out to dry. If you’re the regulator, that leads to being risk-averse, not risk-aware, and a regulatory process that tries to stifle innovation, rather than support it.

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UK Social Care: Challenges Integrating Health and Social Care

January 16, 2020

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