Kings Fund Event 28/02/19 – Health and care explained. An overview.
Key messages from the day by Mike Frazer, People’s Board member
Kings Fund (KF) 1 day event – “Health and Care Explained “Leeds on 28th February 2019
Leeds Councillor Keith Wakefield opened – 50,000 jobs in Leeds are related to health/Life expectancy differs between disadvantaged Holbeck and affluent Alwoodley by 11 years/Social Proscribing works – there are 30,000 people in Leeds involved in community based groups
Alex Bayliss, KF acting policy director – gave a history of the NHS from its founding in 1948 to date and outlined how the NHS had changed since then and significant management structure and commissioning/Provider process changes and how since 2014 changes encouraging collaboration rather than competition had been encouraged as well as a move towards improved public engagement and Primary Care and community based services recently promulgated in the new long term NHS plan -”organisations are trying to collaborate in a system that pits them against each other”.
According to international rankings the NHS performance is overall 1st but health care outcomes especially with Cancers are 10th!
Simon Bottery, KF senior policy fellow, outlined Social Care and how it had developed since the National Assistance Act of 1948.Unlike the NHS budget which is protected by Government most of social care is managed by Local Authorities ( LA ) whose overall budgets have reduced significantly since 2010.Les fund 850,000 long term users of whom two thirds are over 55/212,000 short term users are funded, there are 172,000 self funders in Care Homes and 164,000 self funders receiving home care and this is projected to significantly increase because of means testing (assets (including house value but excluding house value for in home care of £23,250 threshold to qualify for free care) /1.4 million people need Care but don’t get it and the LA spend of £20b pa on care is split one third each on children, working age and the elderly/there are 142,000 hospital beds and 410,000 care home beds/the NHS wage bill is £19.4billion for 1.2 million staff and for Social Care – where staff are often on the minimum wage – the wage bill is £32.2billion for 1.5 million staff and whilst £4.7billion is spent on training in the NHS the comparable spend in Social Care is £21.2 million and the reform of Social Care Government green paper – a consultative process – may be launched in 2019.
Durka Dougall – KF senior consultant spoke on Population Health – a new approach to focusing on the overall physical/mental health and well-being of people and the bigger role that community can play in reducing health inequalities and the improved engagement of the voluntary and community sector in partnerships to improve outcomes and to move away from the traditional separation of health and social care and the silos within which both are managed.
Siva Anandavici, KF senior analyst, covered integration of health and social care and how KF are promoting a vision for population health and aiming to support pilot schemes such as in Wigan to establish a framework to rebalance health and social care by promoting prevention, earlier care and support and a focus on mental resilience and KF have launched a project “New leadership for Population Health” – the big issue for NHS currently is workforce management – the vacancy rate for nurses is 11.4%, medical 7.4%, others 7.5% – according to the NHS staff survey in 2017 725 of staff are working extra hours/385 report work related stress/24% experienced bulling, abuse and harassment. A crucial element of the NHS long term plan is a Workforce Implementation Plan being put together by NHS Improvement. Targets may also be reviewed – the 4hour A&E waiting time is overwhelmingly missed and it can be “gamed “by seeing the majority within the last 10 minutes irrespective of their health issue – one of the few things CEO of NHS Trusts can be sacked for apart from money is the failure to meet national targets.
Ed Cornick of Policy and Strategy at Bradford Teaching spoke about the corrosive impact on delivery of the annual planning cycle and the short term financial pressures this causes which may prevent collaboration to improve outcomes but that significant efforts are being made to extend collaboration and in answer to my question about Bradford’s poor record on getting near the 85% target for a cancer diagnosis within 62 days he specifically mentioned the innovative work by West Yorkshire and Harrogate Cancer Alliance to improve collaboration across NHS trusts within the area and the sharing of staff and equipment resources to improve.
There were breakout sessions in the afternoon on Patient Data sharing led by Harry Evans and the power of mobilising communities led by Helen Gilbert, KF Policy Fellow and David Buck, KF senior Policy Fellow which had a contribution from Lisa Keenan from Leeds City Council on how Leeds is encouraging the growth of community groups to improve health and well being.
It’s obvious that health and social care should be integrated under 1 Government Department and social care not left largely to Local Authorities which have seen their funding cut by a third since 2010 whilst health spending has been protected and Government should publish its green paper on social care reform which has been delayed because of Brexit. Health and social care have been seperate since 1948 when both the NHS and National Assistance Board were introduced but both are too closely linked to keep as separate policy areas.