Encouraging signs from the Department of Health as we await next week’s publication of the health and social care white paper: first, a reaffirmation of the importance of prevention in this week’s “Sure Start” for older people report; second, ministerial support for channelling more NHS money into preventive services; and, finally, social care getting back its place at the DH’s top table rather than picking up the crumbs underneath it.
If this implies a harsh judgement on the officials who currently speak up for social care in the department, it is not intended to. But an NHS monopoly at board level was never going to give social care the fighting chance it desperately needs if the right balance is to be struck with the health service after the white paper comes out.
The DH’s new director of social care will be crucial to luring the NHS away from its obsession with acute care and its apparent belief that prevention, and the well-planned, extensive community services that should run alongside it, ought to be left as far as possible to local government. Most health service money is spent by primary care trusts and much of that ends up in hospital coffers. No doubt that is as it should be, but if even a small proportion of these budgets were converted to community-based preventive services it would be better for patients, users, and indeed, social care as a whole.
Speaking to Community Care this week, care services minister Liam Byrne promised a “very strong emphasis” on prevention in planning the most effective use of health service funding.
Closer integration between councils and PCTs will help. After the latest NHS restructuring, twice as many will share common boundaries and the white paper is likely to prescribe joined-up inspection and performance management so that the two sides’ priorities are brought into line.
Another critical role will be played by councils’ new directors of adult social services. “Sure Start” may be a patronising tag to tie to a service for older people, but the intention is good: the new breed of directors will lead this drive to reduce social exclusion among older people by bringing together a variety of agencies in a common endeavour to promote well-being and prevent illness or harm.
The government has begun to beat out the right tune. But judgement on the full orchestra will have to await the white paper.
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