500 signatures reached
To: to Parliamentarians and agencies
National Care Service
We request the government to make the necessary legal and organisational changes to ensure the establishment of a National Care Service that would bring together hospital care, primacy care, community and social care, funded by general taxation and administered by Local Care Authorities who would respond to the needs of the local community. They would be supported by a Regional structure
Why is this important?
In a recent document, Jacob Rees-Mogg MP wrote, “Every Member of Parliament will be aware of the deep unfairness inherent in the country’s health and social care provision.” This unfairness has been thrown into sharp contrast during the Coronavirus pandemic, but may be traced back to 1948, when the NHS was founded to provide comprehensive healthcare, free at the point of care, for everyone in the country, funded through general taxation. In distinction, social care remained the responsibility of Local Authorities, funded through local taxation, but heavily means-tested and subject to eligibility criteria. Like other parts of the care systems, social care has been significantly underfunded and not fit for purpose.
The provision of social care in England is failing on many counts.
• It is profoundly unfair.
o Nobody can tell when they might require support to live as independent a life as possible, and the cost of such support is unpredictable.
o Cancer sufferers receive care that is free at the point of need, but dementia sufferers are means-tested. People sustaining a stroke resulting in disability are not considered to have a medical problem but a social one.
o Privately funded service users are subsidising state-funded users
• It is inefficient in its use of resources.
o Hospital beds are inappropriately occupied while wrangling takes place over the funding of the ongoing care, rather than the setting that will best meet their ongoing needs.
o There is heavy reliance on informal care, imposing costs on families and the wider economy.
o Transactional costs of the fragmented market eat into resources for actual care.
• It often does not meet the needs of the individual.
o The goal of social care is to allow people to participate as fully as possible in community life, with security and dignity. Too often this is not achieved.
o Care does not always allow people to maximise their potential or exercise the life choices that most of us take for granted.
• It struggles to recruit and retain sufficient carers for the needs of the service;
o Despite the recognition of care workers as being key workers in the response to the pandemic, there is a lack of recognised training standards, qualifications, and career progression.
o Pay and conditions do not reflect the value that society places on those who care for their loved ones and require public subsidy through the benefit system.
• It poses a serious risk of financial collapse of major care home providers, with consequent insecurity for residents and a short-term approach to investment in staff and facilities.
There has been much talk of integrating health and social care, spanning many governments, but paradoxically, successive governments have created divisions rather than integration; the creation of the provider purchaser concept, the internal market, the continued fragmentation of the NHS and the 2012 NHS and Social Care Act are some examples. These have led to increasing lack of coordination between the hospital and primary care. Significantly, the changes have resulted in multiple bodies rather one authority providing the services, resulting in a disorganised service.
The changes we propose would ensure that all parts of the care service would be obliged to collaborate with each other to provide what would be best for the individual and to redress the increasing lack of continuity of care, in addition to producing a fairer, less complex, and more cost-effective service.
Local Care Authority (LCA)
This would replace the local CCG. This would bring together all relevant provider units (hospital care, primary care. community care, social service, mental health and ambulance service) within the influence of the LCA. Each provider would be expected to provide a set of agreed services according to the needs of the local community and avoiding duplication of services. It would be a requirement that representatives of providers include a senior clinician, a member from front-line staff, where these would be relevant. LCA would ensure that the agreed services are delivered efficiently. It would also liaise with the relevant Local Authority in addition to charitable bodies and private providers. Each provider unit would keep its own administrative structures unless they wish certain aspects to be given to the LCA.
LCA would establish agreed governance structures and annual audits readily available to the public.
LCA would liaise with local trade union bodies
LCA would receive allocated resources from the regional authority.
LCA would be expected to establish a confidential and independent office for Freedom to Speak Up.
Regional Care Authority (RCA)
This would replace current structure at a regional level.
This would include representatives from each LCA within the region in addition to those from large providers across the region and tertiary centres, universities, government agents and the Colleges.
It would be responsible for seeking resources from the government on behalf of the LCAs and capital costs.
It would liaise with other relevant RCAs
It would ensure the government policies are understood and delivered throughout the region
It would receive annual reports from LCAs
Commissioning services for those services not available to the National Care Service (ICS) would be carried out by the central government.