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Piecing together the fragments

Finding a solution to the social care conundrum will have a great and lasting bearing on the future of the NHS too.

Long-term condition management will become increasingly important as our population ages, while already the health service, and especially the acute sector, are finding resources siphoned off at an evergreater rate by elderly patients.

Few of these people want to be in hospital, and with earlier intervention and the right kind of social care, many could have avoided the loss of their independence and subsequent reliance on hospital care.

Spiralling demand is obviously causing problems for local authorities too, who can struggle to find adequate provision for people to get them out of hospitals as soon as possible. Dealing with this fragmentation of services is a commonly-stated Government aim, although it comes as much down to money as to structures and processes.

A lot of the ideas are relevant to health more widely, not just social care. Reconfiguring hospital services and having more services offered in the community – better for patients, and ultimately cheaper – is the ideal, recognised by policy-makers and commentators. Ministers will talk about care closer to home, but will rarely be caught going into detail about the fl flipside, closing hospital units, as this remains politically fraught.

Many insightful observers have spotted an obvious upcoming problem for the Government: its NHS reforms will be linked in the public mind with hospital and unit closures. The need to shift away from expensive and unnecessary acute care and towards earlier and fewer interventions, better public health and self-responsibility, care in the home and the community, and fewer, more specialist units dedicated to complex medical and surgical areas is not one with a wider currency outside of specialist health and political circles.

Instead, hospital unit closures will be seen simply as cuts to services driven by the reforms, sometimes with an unhelpful element of local pride thrown in, where people are particularly aggrieved not just that their local hospital facility is going, but that the town or city next door is keeping theirs or even seeing it expand. With acute hospital care having been the ‘default’ in so many people’s minds for so long, changing these views will not be an easy task, and considering the mess that’s been made of messaging around the NHS reforms and the Health & Social Care Bill (still a Bill as NHE went to press, but probably an Act by the time you read this), few would put money on this Government managing it.

Adam Hewitt - Editor

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