1. The obvious one: a proper debate and decision about how we fund health and social care. We spend less than many of our European neighbours on our health and care system but we expect as much – if not more - from it. That’s not realistic. If we want a world class system we need to put our money where our mouth is and pay for it.
2. An end to the ‘us versus them’, ‘government versus doctors’ divisive dialogue in the NHS. It makes the needed reforms less likely. Jeremy Hunt bears big responsibility for this. It’s time to change the tone, Jeremy.
3. At the same time, avoid the temptation to ‘beatify’ the NHS. Let’s hear as much discussion of the OECD report on healthcare systems, which is far from flattering for the NHS, as the Commonwealth Fund’s report in which it was rated top of the field. We can’t escape the fact that the NHS which gives us such brilliant services in so many places also gave us the Mid Staffs andSouthern Health scandals.
4. Let’s have some realism about how integration of health and care is going to work in Manchester and elsewhere. With a developing funding crisis in health and care, we are at risk of clutching at integration like the proverbial straw by a drowning man. Integration may well offer better care but will it be cheaper care? The jury is still out.
5. We need to talk more about families and their role in care and support. Does anyone really believe we can recruit and fund the necessary one million care workers needed in 20 years? No, so models of care will have to change, including a greater state-supported role for those families who want and are able to play it. That will need planning and funding, with measures such as guaranteed paid leave from work and consideration of European models where families are paid to provide care. And of course the Government need to ensure that for those who can't rely on family, whether due to bereavement, bad luck, or bad relationships, there remains a professional system in place that works.
6. Let’s find out what we’re really dealing with in abuse and neglect in care homes. Hidden camera footage is convincing the public that abuse is widespread, scaring families and older people. We lack the evidence to prove it’s not. A full, anonymous survey of staff working in social care settings will tell us what we’re facing. At the same time, hands off the CQC. They’ve started to make progress in inspecting social care in particular, held back by difficulties in recruiting inspectors. It makes no sense to cut its budget now.
7. But just making homes safe is not enough. We need to transform our expectation of care homes. Far too many are still ‘care houses’, keeping older people out of harm’s way but adding little or nothing to quality of life. The norm should be care homes where we hear children laughing and birds singing (literally), where arts and music are a routine part of the day and where the home acts as a hub for its local community.
8. While we’re on care homes, we need way more data about what goes on inside them so that families and older people can make the best decisions. Care homes need to report routinely on measures like staff turnover, staff to resident ratios, safeguarding alerts, A&E attendances. But the drive to get ‘user opinions’ on ‘Trip Advisor type’ websites needs abandoning. If they were ever going to work we’d know by now.
Read the remaining eight wishes in the next part of Simon's blog.