As you point out – if it was easy (and it was possible for one person or organisation or even sector) to get our arms around the scale and scope of what we’ve got and what we need, we might have a better chance of getting more out of how Lansley’s reforms are changing the debates – even as support from across the political spectrum slides (or landslides) away from him.
The thing that most frightens me is that the political fall out from these intensely unpopular proposals means no one touches these questions for decades – much, much too late to get us ready for the changing needs that are coming. If we think the AV/Proportional representation debate has been kicked in to the long grass for a good 20 years by last week’s debacle, how long might the war wounds of this round of debate on the NHS last; stymieing action and preventing anyone raising any kind of critique or radical ideas for change?
So, some observations from the debates this week at POPse! on the role of social investment and social enterprise.
Yes, the long term issues are the hardest. It’s easy to confirm in general terms that we want and need a shift from a sick care system towards services, access and support to make us and keep us healthy. But working out how to shift a service that was designed and developed in a different age is really, really, really tough. We are hampered by political cycles, vested interests, fragmented leadership and an overwhelming sense that why pay today to prevent something that is going to occur on some else watch. Except it’s going to occur to so many of us and ultimately we will all pay for it – personally and collectively. Concerted and honest investment in long term solutions which understand how housing, employment and health are tied are needed. Like:
- Care, education and employment opportunities for people with learning difficulties,
- Incentives for support for smoking cessation, weight loss and medicines management
- Much, much more effective and sustained set of services for mental health.
The way to pay for these kinds of services are likely to remain firmly in the public purse.
Blended return might be available from a range of other services that show clearer savings in the shorter term. We’ve heard a range of examples this week – expansion of residential services for children with autism, an independent childcare introductory service that recruits, screens and trains care-workers and a rapid response ambulance car for older people have all received funding or investment in recognition of the improved service and savings they are making. But there’s a big proviso – full cost recovery and retaining quality services may be mutually exclusive. The unfettered “market” cannot deliver all the resources here.
Finally, the calls for “social enterprise” probably hides a more sophisticated desire/assertion which include:
- A greater desire (and need) for more patient and carer participation in delivery of and control of services.
- More assurance that the health service is responsive to and aware of service users.
- A greater realism that what we want, what we need and what we can afford creates a tension between choices and delivery.
- That the health service should have rights and responsibilities to staff and patients built in.
- That public services mutuals and spin outs should be good for everyone and avoid a second class/two tier service, but senior management in the NHS and running a social enterprise are different roles, which it takes time to learn.