Once more there are rumours of a proposed merger of health and social care. But there are reasons to worry that this could cause more problems than it solves
In recent weeks, we have learned that Sajid Javid is working on a radical plan to merge social care with health in England. The proposal is aimed at freeing up NHS beds and offering home care – and could be included in a white paper next month.
The debate about a national care service is not new. But such a service – which could see health and social care delivered by the same organisation – would be one of the boldest reforms since the founding of the NHS.
So, what does this mean for patients and those in receipt of care? Would such a move improve the experience of how people navigate the system and the quality of care they receive?
Well, you can see logic in the argument. A rapidly ageing population means that there are more and more elderly people needing care and support. It’s particularly true of those with dementia, whose care – illogically, some might say – comes under the remit of social care rather than health. This places significant pressure on local authorities, whose financial resources are stretched. This often results in elderly people being kept in hospital for weeks, while local authorities struggle to identify and put in place an appropriate care package.
However, this doesn’t mean that integrating health and social care as one organisation is the right solution. There are a number of reasons to be cautious.
Generally, the NHS and social care have fundamentally different aims: one is to treat people while they’re ill, the other is to help them live independent lives.
There is disparity between the two sectors. As the pandemic has highlighted, the NHS is an iconic, much-loved and well-recognised national institution. It receives a very high level of funding and, in the main, remains free at the point of delivery. Social care, on the other hand, is managed and delivered by local authorities alongside other private providers, it is under-funded and paid for partly by local authorities and partly by service users. The two don’t seem to make a good merger fit, in that respect.
The re-organisation involved in integrating the two sectors into one organisation would be huge and disruptive. Given the NHS has been through numerous reorganisations in recent years, yet another one would be unwelcome, particularly coming after a pandemic that has left people drained and exhausted.
Under-staffing would continue in both health and social care, even with integration – the same set of problems remain, just differently organised.
Depending on the model of integration used, there could also be issues that emerge around transferring pay, terms and conditions (e.g. disparities between NHS Agenda for Change terms and conditions and other terms and conditions for current social care workers) – which might need to be handled sensitively and carefully. Yes, these things are standard considerations when it comes to mergers, but their potential to cause difficulty should not be underestimated.
Overall, if this proposal is to be part of a white paper, we will need to see what Sajid Javid actually means by bringing social care into the NHS. For those patients and citizens who are tuned into the development of Integrated Care Systems (ICSs), for example, there will be questions about how these latest proposals fit with the establishment of those bodies. The priority must be for people to receive the best care in the most appropriate setting. So how will the proposal help people navigate their way through the system in this context?
Social care is under almost unmanageable strain currently, but we need to think of a better approach for improving it that doesn’t involve a complicated and potentially demoralising reorganisation.
Ultimately, the approach the government adopts should be about centring the needs of the patient, and a structural reorganisation doesn’t seem to achieve that.
"The re-organisation involved in integrating the two sectors into one organisation would be huge and disruptive. Given the NHS has been through numerous reorganisations in recent years, yet another one would be unwelcome, particularly coming after a pandemic that has left people drained and exhausted." Greg Allen, FCC CEO