There is a great deal of talk from the Government and other key stakeholders about the need to integrate health and social care.
This is a very laudable objective, but it will never be achieved whilst we have two separate systems and two very distinct and different approaches to career development.
The NHS spends £100k a minute on training and there are some very clear and defined career pathways in all areas of the service. The pay, conditions and benefits of NHS staff are also much more clearly defined, such as the NHS pension scheme are a real incentive to people entering the organisation and staying within it to progress their careers.
Social care on the other hand, has been neglected and there is no overarching approach to career development, though there are many care providers who have their own very good career pathways and spend a great deal of money on nurturing and supporting their staff.
The reality of the 21st-century is that long-term conditions are our biggest challenge and we need to have a comprehensive review about how we restructure services and develop new career pathways for social care because after all, this is the biggest part of the system.
There have been so many missed opportunities. There was a real hope that the Cavendish Review would usher in a new era of consistency in training and development and that there would be greater opportunity for people to move between employers because there was a clear and consistent starting point to care careers. In writing her report, Camilla Cavendish made a very spirited attempt to deliver a foundation for social care careers, and I think it was disappointing that the Government responded to her review in a piecemeal rather than strategic way. Baroness Cavendish is a powerful advocate for social care and continues to raise the issues of funding, training and support.
What we need for social care careers is a new beginning that has to start with the recognition that integrated services require staff who are trained, developed and rewarded in ways that enable them to move seamlessly across the system in the same way that citizens do.
There is a critical shortage of nurses across the entire system, but because of the amounts of money that the Government allocates for training and pay in the NHS, it is nearly impossible for social care providers to compete, consequently the nursing shortage in social care is becoming critical. Unless there is a strategic attempt to address the interface between health and social care, we will be in constant round of crisis and governments will find themselves unable to find an increasingly beleaguered health and social care system. It is my view that workforce issues have taken equal priority with funding issues as the challenges for social care in the future. There is a great deal of uncertainty surrounding Brexit and what this will mean for our ability to recruit from overseas.
As we move towards this uncertain future. There are some things that the Government need to do as a matter of urgency to create a foundation on which we can build. The most obvious thing they need to do is review the criteria of the Migration Advisory Committee, which in the future needs to be clearly focused on the skills required rather than the salary levels of the staff. If we don’t get this right, we will not only see a shortage of staff in our essential services, but there will also be the knock-on effect of other parts of the economy competing for the same pool of labour.
If ever we have needed some strong vision from the Government about the workforce and the future of health and social care, we need it now. Sadly, I see little evidence that it will be delivered and the constant prevarication on the funding of social care is pushing the sector towards a crisis and making the governments ambition for integration impossible to deliver.