Following up my post on patient voice in the Health White Paper, here’s one capturing my confusion over how health relates to social care.
It is baffling to me that a White Paper entitled “Liberating the NHS” makes so many references to social care. Indeed, the White Paper may be liberating the NHS, but it feels like it’s making a landgrab for social care.
The direction of travel all seems to be from social care to the NHS. Take paragraph 4.19, for example:
Local authorities [will have] influence over NHS commissioning and [there is] corresponding influence for NHS commissioners in relation to public health and social care. NHS commissioning will be the sole preserve of the NHS Commissioning Board and GP consortia.
At the end of the White Paper (para 6.7), it’s casually dropped in that the role of NICE will be extended to social care. Why? David Brindle notes the concerns wonderfully here, and what it might mean for social care more generally:
[T]he decision to extend Nice’s writ raises questions about the continued separate identity of social care. The sector has long pressed for the joining-up of health and social care – and the white paper seeks to promote this, particularly through the proposed new role for local government in respect of public health – but the ambition has been on the basis of equal partnership.
Nice’s planned move into social care, coming after the collapse last year of the Commission for Social Care Inspection into the Care Quality Commission, suggests that health is being seen very much as the senior partner in this relationship.
Is this the right way round? Figures out this week indicate that the social care sector employed 1.6 million workers in England alone in 2009, an increase of almost 250,000 on a previous estimate for 2007-08. Some of the rise is ascribed to better data collection, but mostly to soaring demand for care services.
The total is significantly higher than that for the NHS workforce, often described as one of the largest in the world, and whereas recruitment in health has been funded by public spending, it is the market that is driving the growth of social care. Of the 1.6 million workers enumerated by Skills for Care, the social care skills agency, 1.2 million are in the private and voluntary sectors.
In business, the acquisition of a big company by a smaller one is sometimes called a reverse merger. Or a reverse takeover.