Integrated Care? Only if We Get Our Heads Out Of The Sand.On the 1st November the government website posted a piece by Norman Lamb ‘Care and Support Minister Norman Lamb on the importance of integrated care and the ‘integration pioneers’ who are leading the way.’ In essence it’s a call to arms for all those involved in caring whether health or social to find ways of working together. There are fourteen integrated care schemes already across the country. Mr Lamb’s piece is impassioned and sodden with the kind of rhetoric we expect from strong leaders. It stirs the blood. You can read it here
Now, I’m a bit of a sucker for the kind of rhetoric he uses. I think it must stem from my days as a soldier. Say the right things, wind me up, point me in the general direction of the enemy and watch me go, and in the reckless days of my youth that’s exactly what would happen. I like to think I’m older and wiser now, so I read it through a couple of times. A part of me wishes I hadn’t, that I’d pulled myself up before the hurdle of cynicism loomed. Too high to get over, too wide to go around. Closer inspection of his statement led me to question the following:
‘Too often people in our country experience failures of care. Not because health and care professionals lack skill or compassion. Not because of money. But because health and care services are uncoordinated, sometimes uncommunicative, and centred around what suits organisations and structures, rather than what helps people lead good lives.’
Yes, Yes. Oh hang about, no. He’s only partially correct there. In fact I’d like to draw his and your attention to a couple of errors in that part of his statement.
Firstly there’s the bit about skill. With regard to frontline care workers there is a definite lack of skill and dare I say confidence due to a lack of good quality training combined with poor support and over the past two years two of the guys with learning disabilities I work for have been hospitalised and the nurses lacked the skill or motivation to understand and react to their needs and got very defensive when, very politely, they were told as much.
Secondly it’s the ‘Not because of money’ part. If he’d said something along the lines of, not ONLY because of money, he would have had me eating from his hand. But he didn’t he stated ‘Not because of money’ and that statement again is only partially true. Skills aren’t innate, they’re taught. Teaching skills to people takes time and in a capitalist society time is money. People want to be paid for the time they give. You do a job you get paid, you teach people how to do a job, you get paid, you embark on training that your employer insists you need to stay employed, you get paid. It really is that simple. If you’re a frontline care worker you can’t afford to give your services voluntarily because you get paid so little.
Then there’s the fact that like most of the articles and speeches that I’ve read about the call to integrated care in the media, this one is almost entirely dedicated to the effect on healthcare. I have a theory about that and it goes like this. Social care has become so sectarian now as to be almost un-manageable. I use the word sectarian because there are so many private care providers, each of them despite their protestations to the contrary, ultimately working for their own gain. They have to in order to stay in business. Trying to get them to work together with each other or any other service will be akin to herding cats. Many of them will not want to lose business and will protect their interests regardless of the needs of those they support. So I doubt you’ll see the subject of social care explored in any depth. It’s too sticky. Best we keep it sidelined.
Believe it or not I am an advocate for integrated care services. I also believe that innovation, especially in social care has a huge role to play. I really want it to work, the integration of care services is a necessity, and for my part I already am and will continue to work with the host of other agencies that are involved in the care of those I support. How about we approach the subject in a way that looks at all the issues? Money, mainly the lack of it and the splintered private social care system to name two. It’ll need strong, expert leadership to bring all the aspects of health and social care together and judging from his statement Mr Lamb lacks at least one of those qualities, his approach, judging by his statement is simplistic and I suspect bordering on neurotic. I wonder if he is out of his depth.
Carl Spaul is a support worker for people with learning disabilities. Both for a private care provider and as a self-employed personal assistant. Contact him via Twitter on @Carl_Spaul