Despite the long wait for its publication, there is much to applaud in the new White Paper, which is a key piece in the puzzle of the government’s plans for wider reform of Health and Social Care. It appears genuinely ambitious in its intention to promote radical change at speed in our current fragmented and convolutedly Byzantine system of health and care, though there is little in its thinking that is fundamentally new.
It is refreshing, however, to see a document that reflects overtly the values that underpin a more compassionate approach to holistic, wrap-around, person-centred care and support, (not least, like me, to those with multiple long term conditions). C4PC strongly supports its emphasis too on giving more influence to the voice of lived experience in the design, delivery and management of integrated services, which give greater personal choice, as well as backing the White Paper’s focus on place-based outcomes that matter most to both individuals and to local communities.
The apparent lack of top-down government prescription about how integrated services should be formed, and the White Paper’s focus on prevention and early intervention, are the right way forward-as is a willingness to see innovative new approaches to overcoming the deficits of the current system, which COVID has exposed.
But, without an effective narrative about the benefits of such changes for both service users and staff in future, public confidence is unlikely to grow. With our use of good practice case studies and the voices of lived experience,this is an aspect where C4PC can make a real difference,and where we plan to enhance our support. We can show what the emerging better future looks and feels like.
Although many of the White Paper’s proposals are likely to be widely supported, both within the NHS and elsewhere, the document has had a cool reception. The reasons for this lie largely in the important things it has left out:
* although there is much about NHS reform, the fragility of social care and the need for a rethink of such services, as well as of Public Health, is not recognised;
* the need for some years yet to give priority to the pandemic’s treatment backlog will slow necessary change;
* there is no certainty about long term funding and investment to sustain the changes;
* there is no clarity about how the different tiers (national, regional and local) will work together, and how local determination of outcomes can sit alongside new powers for Ministers to intervene operationally and on national priorities and outcomes;
* the critical element of necessary improvements in the wider determinants of health and well-being, (such as better quality housing and secure, well-paid employment), are barely mentioned;
* there is no recognition of how the crucial role to be played locally by the VCSE sector will depend on sustainable investment and on new approaches to commissioning which move away from competition and encourage greater diversity of (local) providers;
* the proposed changes apply only in England and other models already exist in Scotland and Wales; and
* health inequalities are not addressed nor are the dangers that a rapid shift to self-serve digital services online risk increasing such disparities for those whose needs are greatest.
There seems to be a growing consensus that the White Paper is flawed because it places too much faith in structural solutions and not enough on the time and processes needed to build trusting relationships which change attitudes and behaviours, as well as organisational cultures that create common goals and a cohesive sense of sharing and reciprocal obligations to collaborate across the whole system.
Even more worrying, is the absence of any national plan to tackle workforce shortages, recruitment and retention difficulties, parity of esteem and pay, and reskilling (particularly in Social Care). Without this,the White Paper will fail to realise its ambitions.
The White Paper is a good starting place, but more is needed to make its compelling vision a reality. Integrating services alone is not enough to give us all the quality of health and care support we need and deserve. To ensure this happens, C4PC will continue to press for Personalised Care to be the default approach in all health and care settings. We will also find better ways to showcase the benefits for users and staff, where such good practice is already happening or is emerging.