Interview: Professor Martin Green
the public whenever there’s a problem in the NHS is to say: ‘the government hasn’t given them enough money’, and then the government gives [the NHS] more money. Unless they break that cycle, we
will never have a functioning NHS, and actually all this crap that we’re told about the NHS being the best system in the world is absolute rubbish. There are many systems that are cheaper and better, but we’ve deluded ourselves after 70 years of propaganda saying ‘the NHS is wonderful’ – well, go and talk to somebody who’s waited two and a half years for a hip replacement in pain whether they think the NHS is wonderful.
The other issue is – I’m sick of hearing that the NHS is ‘free’. It’s not free. We pay through the nose for it.
TCHE: To criticise the NHS is almost to challenge a sort of religious orthodoxy. It’s not functioning properly and people are actually not getting a basic level of care, but you can’t really say these things. MG: Well, you can’t because it’s become a national religion. It was brought home to me by the prime minister saying: ‘stay at home, protect the NHS, save lives’, as if the NHS was an end in itself. It should have been about protecting lives, and the NHS is there to support us. We’re not there to support it. It’s like saying to people: ‘don’t take your money out of Barclays Bank - protect their profits’. It’s ridiculous.
TCHE: I want to talk a bit more about integration, and specifically digitisation, which is often held up as the answer to everything. Is it? MG: I think [digitisation] has its place, but I want to reclaim the term ‘integration’ and I want it to be about the experience of the person who receives the service. The best way to deliver integration is to give everybody the same measure of success, and the measure of success should be the outcomes to the person and the effective use of the resources. And if everybody was working to those two big global measures of success, then the system would be much more integrated.
There are so many things that social care can do that the NHS currently does and - interestingly - during the pandemic, when the NHS abandoned social care, suddenly social care staff were doing stuff that they had [previously] been told: ‘you can’t possibly do that - you need an
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NHS professional’ – well, when the NHS professionals completely abandoned us, suddenly care workers were doing that. I think part of problem is nobody knows
how to align the measures of success, and if you look at a lot of the measures of success, they’re all organisational and transactional – they’re not about outcomes. The best way to ensure integration would
be to have clear unified measures of success, and then to work backwards from there and say: are we getting the best value? Are we getting the best outcomes? And if you did that, you’d have an integrated system.
TCHE: With the High Court having ruled that the government’s care home discharge policy during the pandemic was unlawful, are we any closer to truly holding somebody to account for those poor decisions, and even if we did, would it make any difference? MG: My view is it wouldn’t make any difference. One of the things that I hope the public inquiry will do is not to look at a blame game, but rather will do a forensic analysis and say: ‘if we had taken different decisions at these points, it would have been better’. Everybody wants to point a finger at
a government minister or the CEO of a hospital or care home and say: ‘they should have done this, they should have done that’, when actually we need to look at these things in the round and systematically say: ‘where were the challenges?’. There was a lot of time and energy and money spent on pandemic planning, but
it was all about pandemic planning in the NHS – they seemed to have forgotten there was a social care system, and that some of the most vulnerable are in social care, not the NHS, but they didn’t acknowledge that in the way they planned. So, in future, I would want an integrated approach to planning for a pandemic, and that would be something tangible that came out of a public inquiry.
As far as that particular court case is concerned, it is one of many where judgments are made, the publicity is high, but the outcomes are zero.
TCHE: There’s so much raw feeling, so much trauma amongst people working in social care. Going forward, what’s to stop it all happening again? MG: I’m confident in the public enquiry - not least because of who is chairing it. [Rt Hon Baroness Heather Carol Hallett DBE] is a very experienced and very independent person, and she, of course, did the 7/7 bombing enquiry, so she has good experience around this and I’m confident that she will come up with a range of tangible things that need to be done. And that will then hopefully translate into the system changing. These things do tend to happen slowly and they happen over time. One of the things that I tell my members constantly is: do not look to government for solutions. They’ve never delivered solutions. They never will. I think our sector needs to try and craft its own solutions. The best way to get what you need is to take the power into your own hands.
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www.thecarehomeenvironment.com September 2022
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