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Winter work


Fixing social care will help the NHS


George Coxon, author.


Week after week we hear fine and important words from the highest profile names in our health and care sectors responding to politician’s statements and promises to deal with the stresses and pressures across the NHS and social care system.

Planned reforms; cash injections; long term solutions; integrated care systems: and yet hospitals are packed full of sizable numbers of patients – many older people – with care and nursing homes on the brink of collapse due to a chronic lack of staff. The term, ‘perfect storm’, is becoming a regularly repeated expression, with a dangerous climate of accusing finger-pointing and blame being seen, even within our own rank and file. 

Fixing social care will help the NHS. But what steps do we need to take?

I have written about this before many times, as others have too. I have been invited to King’s Fund roundtable events, special meetings with the Health Foundation, and join All Party Parliamentary Committees at regular intervals; I am leading a section of work on ‘Reinventing Social Care’ with exceptional colleagues across the country, and have a whole page in a recent British Geriatric Society newsletter… and yet our collective efforts lead to more frustrations and no concrete actions let alone solutions’.

I spent some of a recent weekend doing a clear out; reorganising the volume of reports on addressing how fixing social care will help the NHS. These are going back many years, and all still very pertinent and largely saying the same things: partnership, restructuring, collaboration, leadership, hearts and minds, etc. What else can we now say – and more importantly do – to address the perpetual crisis we endure year on year? This is made more desperate this winter by the protracted issues of the pandemic, Brexit and general demand and supply challenges.

Offering a personal and perhaps controversial set of recommendations here might just stir things up. Oddly, I was recently accused of ‘toxic niceness’ in a Twitter exchange when speaking up about the need to elevate the status of care staff in social care. I seemed to have inadvertently touched a nerve about the protected characteristic of being a nurse (accidental on my part).

Why this is relevant to the fixing social care is to do with status, trust, respect and parity – and how a broken, depleted, haemorrhaging social care workforce will mean capacity for onward care for the 30 to 40% of ‘green to go’ patients languishing in hospital each day through no fault of their own nor of the clinical staff.

I have been referring to ‘bulge management’ for many years: squeeze social care and the pressure pops up in the NHS. The objectives of ‘home first’ and initiatives like ‘discharge to assess’ and ending pyjamas paralysis – while laudable and reflective of most people’s choices – will often be high risk where community onward care and follow up from home care support is as ravaged as residential care.

My past roles in clinical nursing services: managing community teams; having a significant role with heart failure and palliative care nurses, as well as responsibilities for several years for community mental health nurses, has left me with much frustration about how ponderous and bureaucracy heavy our responsiveness is. The Buurtzog model, developed in Holland and now being adapted more in the UK, is a way of empowering front line clinical support and with a stronger credible link with social care this too might help better flow for people and greater success with our care hand offs and transfers. 

The prevention of the more common reasons for admission to hospital and promotion of independence relies on early detection and risk assessment – this clearly is where GPNs have a big part to play. But do they have capacity? Reaching the most vulnerable and the hardest to reach can be very time-consuming and far from easy.

My final point, and perhaps needing to declare my bias as a positive noise-making care home activist, is to say to all those reading this piece: please befriend your local care home. Encourage all your friends and family to befriend it too – to help make it the kind of place for people to look forward to living in when the time is right (not too late or after a series of avoidable admissions to hospital).

By doing this you will be playing your part in fixing social care and helping our status and image, as well as sustainability, while also getting the buzz we get from making a difference to the lives of those we look after.