Stuart Lindsay

The Green Paper principles: a cautious welcome

March 27, 2018

In a speech earlier this month, Secretary of State for Health and Social Care, Jeremy Hunt, outlined what we can expect from the forthcoming Green Paper on care and support for older people.

I was pleased to see that many of the recommendations that iMPOWER made in our recent report (‘The two billion pound question: Is there an opportunity to move from meeting to managing demand?’) are reflected within the 7 key principles he set out in the speech.

Our report called on Mr Hunt and others in central government to create the right environment to incentivise and empower local decision makers at the interfaces between health and social care to deliver reform. Our recommendations for the Green Paper include:

  • NHS and care interfaces: We have seen evidence this year that increasing demand and financial difficulties within the NHS have a direct knock on effect for local councils’ ability to manage demand and costs within social care. If the Green Paper is focused on providing a solution to sustainability in social care and this is impacted directly by NHS sustainability, a similar plan needs to be constructed (or re-visited) within the NHS, preferably as a joint solution.
  • Incentives: the focus on Delayed Transfers of Care (DTOC) during 2017/18 has successfully reduced bed-blocking at a national level.  However, there are also unintended negative consequences to this narrow focus, including rising numbers of emergency hospital admissions and likely increases in the number of long-term care packages being commissioned. The performance incentives and targets set by the Department of Health and Social Care have a significant impact in driving daily decision making at a local level, and the reforms proposed within the Green Paper therefore must be aligned.
  • Functional enablers: integrated care provision was a core component within the 7 principles, and was prioritised ahead of structural change. While we endorse this approach, for integrated care provision to succeed, there are important barriers that need to be overcome to support effective integrated decision making. These include finance (risk sharing and planning), information (sharing, systems, communication), estates (optimum use, shared facilities) and workforce (roles, processes / protocols, culture change and behaviours).
  • Time: the changes proposed in terms of workforce development, adoption of technology and information, integrated working between professional staff, and the development of new services and markets in delivering personalisation all require people to think and act differently.  This requires time. Whilst this should not prevent action, the approach and deliverables need to recognise the ingrained cultural beliefs that drive behaviours and practical decision making on a day-to-day basis, and these take time and ongoing reinforcement to change.
  • Community offer: the existing system – resources, workforce, targets and branding – are all skewed towards acute and long-term care. Creating a stable, vibrant market in supporting personalisation, adoption of technology and maximising independence requires parallel investment in the community. Cost and funding shifts will not deliver immediate change (as demonstrated through the lack of material progress under the Better Care Fund), as it takes time to develop a market and for people to engage with these as alternatives.

There was much to support in the Secretary of State’s speech. But the acid test will be actions taken to deliver this vision at a local level and create an environment that incentivises reform.

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