The most important change is to fund social care properly so the quality of care is everywhere appropriate. The need for a properly skilled, motivated, well managed and properly remunerated workforce is essential.  Moving all those employed as care providers onto some system like Agenda for Change is supported.

Early discussions with Royal Colleges and LGA is essential to ensure there is not unnecessary opposition to the principles.  The small group of pro-market care professionals should be isolated and confronted.  We should identify and promote pro public professionals of repute.  We should continue to show the failures that marketisation has brought.

We support integration in the sense of making care person centered and support (in general) the description of this favoured by Patient Voices.  Care planning for an individual must take into account environmental factors, housing and benefits.

We support structural integration as part of the move towards cultural and behavioural change; necessary to deliver integrated care.  We also support structural integration where this will deliver economies of scale and more rational investment incentives.  We do not see “integration” delivering major savings but it should deliver better care.

We support the need for commissioning by local authorities, in the sense of planning and specifying service requirements and deciding on priorities but only within a managed system.  The use of procurement should be restricted by a preferred provider approach.  We should look to growth of local authorities as providers of care not just procurers of care.  Public investment in care infrastructure should be encouraged and incentivised.

The shift to local authorities must be gradual and must use so far as is possible, the existing organisational units.  An incremental start would be for LA’s to widen the scope of local wellbeing strategies and then ensure they are implemented.

We agreed that assessment of needs (as started by the current Care Bill) was complicated and required some safeguards, but the principle of a single national portable assessment process suitably informed by shared decision making and advocacy as appropriate is the way forward.

We support the general principle that standards and basic entitlements are set nationally, and this is monitored and enforced.  We support the principles around NICE and see that as extending into social care.  The NHS Constitution should be widened to cover all care.

The principle that entitlement is set nationally but the delivery is determined locally must be tempered by the need for some genuine local autonomy, to make local democracy have greater meaning.  Structures and systems for provision should be decided locally and we may see different approaches in different settings.  Local authorities are not generally subject to top down enforcement as NHS bodies are.

The role of the local authority as the strategic commissioner is accepted but with due caution –
given the problems currently with commissioning of social care. The poor perception of local government and the hostility between local authorities and health bodies has to be addressed long before policy is announced and implementation planned.

We support the principle that a personal budget may be suitable for some – but there can be no compulsion or even direction.  There can be no prohibition of top ups but the quality of care should be such as to make this less attractive and unnecessary.

We support the progressive change to providing social care free at the point of need as with health care but accept this will have to be implemented over time – progressively widening the scope of free (ie not means tested) entitlement. Some aspects of care (“hotel costs”) would remain means tested.  We agreed that funding for this in the long term should come from progressive general taxation (as with health) but that there would have to be an alternative such as a levy on estates in the short term.

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4 Comments

  1. My only comment would be that the NHS was set up to provide care facilities free at the point of use and care from the cradle to the grave.

    The private sector does not have a roll in that, they are too expensive and profits mean less money for direct care.

    Where since this madness began have we seen a private provider that has successfully paid it’s employees the same benefits and working conditions that the public sector previously provide. The private sector’s prime concern is profits not patient care. We pay more for less in the private sector and you only have to look across to the United states to see it.

    People are ignorant as to why we are where we are economically, they know something does not add up but are confused by the media who conflate the issues, to obscure the Neo-Liberal agenda.

    Whilst society focuses on budgets rather than the resources necessary to provide what society wants; we will never have care provision to the standards we achieved in the sixties and seventies.

    It should be obvious to most by now we can finance wars at the drop of a hat and so proves when governments want to spend the money is always there. This is the twenty first century and history demonstrates how in the past people were duped by the political elite to accept their version of events, today we have the means to think for ourselves, it is only the capitalist system that is holding us back.

  2. PH Practitioner says:

    This sounds very nice and woolly apart from the bit about strategic commissioning and not prohibiting top up payments. Commissionining means that profit-driven companies will be tendering for contracts. Top up payments means user payments for anything above a bare minimum.

    This article shows how New Labour operates. The SHA sounds like a Socialist organisation. Richard Bourne is a wealthy management consultant who made a lot of money from the NHS during the New Labour years, when privatisation and PFI were being introduced. The article starts off by by making some vague comments the workforce. It portays care professionals as being pro-market. I’ve never met a care worker who was pro market, but I’ve met a lot of businessmen who were pro market. Care workers work in underfunded units, trying to fill gaps and provide the vulnerable with decent care. Strategic commissioning is a grandiose phrase which means businesssmen profiting from public funds.

    Top up payments are great for businesses running no frills care homes, but they are bad for service users who cant afford to pay extra. There wouldnt be profit-driven care services if we scrapped commissioning.

  3. Martin Rathfelder says:

    I don’t think PHP has read the article very carefully. Richard does not suggest that most professionals are pro-market – quite the opposite.

    How could you possibly prevent people paying extra for social care out of their own pocket?

  4. Shibley says:

    Thanks PHP for the time you have taken once again in commenting.

    I think, in fairness, the author of this article is reporting current responses to ongoing work, and is not stating a personal opinion as such.

    Many of the points in the article I think are reasonable, though I am not in any sense of the imagination a supporter of the New Labour era. I think most of us have agreed to move on, whatever our sentiments about the relative merits of policy there.

    There’s a huge debate about to blow up about co-payments and top-up payments, I feel, in light of the fact how precisely CCGs transfer funds between each other, and the relationship between the state and the private insurance system. I personally do not support integration of the two systems, in that I want a state-run NHS and social care service properly funded offering a comprehensive, universal, free-at-the-point-of-use service; but somewhere in the pipeline (and I don’t know where and when, or by whom) is the discussion to be had about how adult social care is to be funded.

    Andy Burnham and colleagues will have to consider whether a mandatory national state insurance system for social care is indeed feasible or advisable, whether other models are better or worse, and how this overall fits in with the projected funding of the health service. I have written recently a number of articles here promoting socialism in the NHS most recently, and my attitude is in working out where to go, “I wouldn’t start from here”. Overall, I feel though the discussion is ‘better out than in’, and the Socialist Health Association has its part to play too. (I am not a member of the SHA hierarchy for clarity, just a member.)

    It might be very helpful if you were to submit an (unedited) article establishing the case from your perspective, as you are clearly very knowledgeable about this area?

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