Q&A
You would then find yourself having to live on the amount of tax revenue raised and Scotland has about three million people paying tax, so I don’t know how they are going to fund that. They can only fund it because of the Barnett formula.
TCHE:During the Covid epidemic, you have often spoken about integration of the NHS and social care. What are the barriers to closer integration between health and care services?
Green: The issue about integration with the NHS is the obsession with organisation. They talk about integration as if it’s somehow all about the NHS or local authorities or care providers. But integration is really about service user experience.
To give you an example, before Covid I used to travel a lot. I’d go to the airport in a car owned by one company, I then checked in at a desk by people employed by another company, then I went into a lounge and get on a plane, all belonging to different organisations. I would then leave, say, German airspace and enter Austrian airspace without knowing when I did so.
All I experienced was a flight from A to B. That was the whole measure of doing all those things while flying - it was the outcome to me as a passenger. Our problem with health and social care is that we have got so hung up with the organisations that we have forgotten what they are there for in the first place. That was very graphically illustrated to me during the Covid crisis when the slogan was ‘Stay Home, Protect the NHS, Save Lives’, as if somehow protecting the NHS was even more important than saving lives. The NHS is not there as an end in itself, it’s there to save lives and protect public health.
So, our problem is the whole
integration piece is being thought of in the wrong way. We need to see integration about outcomes, not organisations. We need to shift our focus from organisations and structures to outcomes and people. If we do that, we will have an integrated system. It would never happen in this country due to the public perception of the NHS, but what we need is a system that says if you don’t deliver that integration you’re not getting the funding.
TCHE: How would you go about having closer integration between the health system and social care?
Green:You have to change the success measures and the funding streams. If you do that, you will be in a much better position to have an integrated system. Everybody knows that working more closely together is how are you are seen as a success and also how you are paid. At the moment, there is so much silo thinking and endless discussion about budgets. Where Covid has been really useful is around hospital bed-blocking in winter. The reason for bed-blocking is argument between local authorities and health
service trusts about who pays for what. It would be better if we just had budgets that follow people. We could then say it may be better to have a person at home and supported properly. That would be better for people and the system. Of course, at the moment what happens is people in the acute trust defend their budget, people in the community trust defend their budget, people in the local authority defend their budget, and care providers have to dance to the local authority
commissioning manager rather than the person who uses the service. So, at every point you have a vested interest who tries to protect their area rather than use resources for the outcomes of the system. And that is where we need to change the paradigm.
TCHE: How worried are you about the capability of the health system to cope with Covid and the impact on care home residents this winter?
Green: I am as worried about seasonal flu than I am about Covid. One of the challenges is understanding the issues around how different diseases come together simultaneously, and I think that will be a problem in the winter if we don’t have a really coherent response. If we can get some of those blockages in the system opened up, you can then find yourself absolutely in a space where it can work. But it needs people working together on this issue to find a solution, rather than ‘This is my bit and I’m not relinquishing any resources because that’s your bit and that’s not my problem’. There are enough resources in the system to cope if they are allocated properly. The issue is about how we allocate them and we make sure that they are all facing the same direction towards public health, and not worrying about organisation.
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TCHE
www.thecarehomeenvironment.com • November 2020
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