While the extra iBCF funding recognised that one part of the system (social care) could have a fundamental impact on the performance of another part (health), it was never going to be easy to deliver sustainable change in such a short timeframe. The cultural differences between the NHS and local councils’ Adult Social Care departments has been highlighted in their expectations of how the funding should be used and where it should have the greatest impact. The poor behaviours and actions of Government, regulators, lobbyists and interest groups in driving their own agendas over the last six months has inhibited local systems in delivering a sustainable future, with improved outcomes for people.
Central government needs to reframe health and social care. To create a sustainable health and social care system, they should move away from a narrative that focuses on trying to cope with demand at an organisational level and which may be driving people into long term care, towards one which emphasises independence and resilience, avoiding admission to hospital, and avoiding reliance on long-term care.
Achieving this relies in part on creating the right kind of environment at a national level to encourage local leaders to invest in admissions avoidance as well as creating the capacity and capability outside of hospitals and long-term care that can support efforts to maximise independence. That means putting in place the framework to incentivise medium term planning and encourage a co-ordinated approach in investing resources (time, money, people) in developing services, workforce planning and evidence. There are a few critical elements within the development of this framework:
- A resolution on the future of the Better Care Fund and more importantly system funding;
- Creating the right regulatory and political environment through appropriate and aligned system, organisational and personal incentives is vital in empowering local systems to take
responsibility for their actions;
- Ensuring that appropriate financial risk sharing mechanisms are in place locally that incentivise
joint decision making but prevent risk transfer;
- Ensuring performance reporting is managed locally based on local needs and is appropriate
for the level of investment
It also requires delivering this new narrative consistently across all relevant government departments and associated bodies.