Experts, politicians, third-sector organisations, and industry players all met to discuss the key challenges within the UK’s health and social care sector, and how these can be overcome going forwards. Headline speakers from the political sphere included Karin Smyth MP, Shadow Health Minister, Steve Brine MP, Chair of the Health and Social Care Select Committee, and Daisy Cooper MP, Deputy Leader of the Liberal Democrats.
With a General Election on the horizon, there was discussion on the perceived failures of the current and previous governments amid the NHS and health and social care sector facing the most challenging time in history. Equally, there was political positioning of potential changes that could be in store depending on the colour of the winning party. Interestingly, challenges identified were broadly recognised across party lines and fell into the core themes identified below. What was lacking, however, was a true sense on how a future state that addresses the underlying challenges is truly patient-centric and dignifies workers can truly be realised and, ultimately, funded. In summary, there seems to be a reasonable consensus on the direction of travel for a robust health system to evolve, and the core themes below outline that, but further thinking needs to occur on how, exactly, we get there.
The core themes identified were:
- Preventative health and moving activity upstream
- A cross-departmental, public health approach
- Social care workforce and a National Care Service
- Need for continuity in policy design, systems, and interventions
- Digital / data and its potential
- Life science research and development in the UK
In this article, we will focus on perhaps the three most pertinent of these – preventative health, public health, and the tragedy of adult social care and its future.
1. Preventative health and moving activity upstream
If there were one major thread running through the panels, it was around the need to focus on prevention, moving healthcare from reactive to proactive. Be it through more and earlier screening and diagnosis, better personalised data, new drugs, and, for the techno-optimists, new technology to support people before it becomes too late and they are showing up at the hospital front door (to put it bluntly).
The evidence base for a preventative approach to healthcare is well documented, yet it is often ‘unseen’ to both service users and the wider public. This then, is the crux: prevention is hard to measure, relies on a wide, holistic approach to health (e.g., inequalities, education, housing as discussed in the next section), and can take years to ingrain and realise. We can all agree that it is a sensible and necessary approach, but it will take a brave government to empower prevention as a central tenet of its healthcare policy. Especially as it will likely require the movement of funding from the overstretched acute sector who are unlikely to see the benefit in the short term.
2. A cross-departmental, holistic approach to public health
From the speakers in the room, it appears all three major parties are in agreement that there is a need for a public health approach to healthcare, with health permeating throughout government policy. Both Labour and the Liberal Democrats believe in the creation of a cross-government board to enable health policy considerations across all areas (e.g., environment, housing, poverty). For the Liberal Democrats, this would be the ‘Health Creation Unit’ in Number 10, alongside a ‘Neighbourhood Health Service’ to empower people to receive care closer to home.
The rationale for a public health approach differs between political persuasion. The Liberals are more interested in the ‘health and wealth’ idea with, supposedly, close to two million of the 8 million on NHS waiting list being too ill to work. Labour’s reasoning is from the viewpoint of equity, looking at inequalities across education, income, and race and how these have such a big impact on future health outcomes.
How public health can best be impacted, and at what level of government delivery of public health initiatives should be realised was generally agreed to be at the local level. Whilst this may feel like just another attempt of central government pushing more work to over-stretched and under-resourced local authorities, a representative from the West Midlands Combined Authority detailed specific policy interventions they had made that were applicable to the geography and demography of the West Midlands. The local theatre where interactions take place also tied into the idea of proportionate universalism, with the Covid-19 vaccine roll-out shown as an example where increased intensity and prioritisation of low-vaccine neighbourhoods was almost carried out on a street-by-street basis.
3. Social care workforce and a National Care Service
Throughout the day, workforce was constantly mentioned but nearly always in the context of adult social care provision. The secondary and primary care workforce was mentioned in passing as a challenge but never analysed or dissected.
Instead, a lot of time was spent on the wicked problem of adult social care. The statistics outlined were incredibly stark:
- Social care provision takes up to 70% of some Local Authority budgets.
- 20% of the population will be living with a major acuity or illness by 2040
- 152,000 vacancies in social care (1 in 10 of the workforce)
- 392,000 have left or moved roles in the last year (1 in 4)
- 45% of home support workers are on zero hours contracts
- The Care economy underpins the real economy and accounts for more GDP than tourism and other sectors
And yet, despite these shocking numbers and the severity of the challenge, very little has been done with social care not included in the workforce long-term plan. Why it hasn’t been tackled appears to be that:
- an aging population (and care workforce for that matter) has been put in the ‘too difficult to deal with box’ by successive governments
- adult social care has a level of invisibility to it when compared to other domains of healthcare
The invisibility stems from large demographic changes but no changes in the assumptions that underpin those groups. Health policy currently appears to not always consider the social care dimension at all, which is as much about the social as it is the medical. Care workers are incredibly undervalued and maligned, leaving a sector in crisis. It doesn’t deliver for patients or staff or, due to existing commissioning arrangements, the taxpayer.
The panels essentially argued that to tackle adult social care, we require a ‘reset’ to develop the visibility of social care and to bring the public ‘on a journey’. The Fabian Society’s vision of a National Care Service (NCS) has been partially coopted by Labour and it is considered that it will create a social care system with a higher status. Higher pay will inevitably be part of this, with collective bargaining and a set of minimum standards for care across the country regardless of provider. Whilst delivery and models of care will be local, a NCS would be able to scale up good practice and examples of innovation.
To sum up, the New Statesman Future of Healthcare Conference shed light on the critical challenges facing the UK’s health and social care sector.
The discussions highlighted the urgent need to shift towards a patient-centric, preventative healthcare approach, promote a cross-departmental, holistic public health strategy, and address the pressing issues within the adult social care workforce. It is evident that the future of healthcare in the UK hinges on innovative solutions and a collective commitment from all stakeholders involved.
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