Breaking down barriers

Professor Martin Green OBE, Chief Executive, Care England

Breaking down the barriers of social care is yet again in the spotlight and the Government is bringing forward proposals for reform. Much of the discussion is focused on how much older people will have to pay for their care, and it is disappointing that the Government did not use the opportunity of reform to revision social care to establish what each individual citizen can expect from the state.

There is a desperate need to ensure that there is an agreed vision for social care, which citizens understand, and a series of clear commitments need to be made by the Government which should be implemented in a consistent way, so that every citizen has the same access to care and support. The focus of this approach must be personalised care and building on peoples assets, rather than the current system, which is all focused on deficits and what people cannot do. There also needs to be a recognition that social care goes far beyond the support offered to older people, and many people with learning disabilities and autism, as well as physical and mental health conditions are recipients of social care.

If we are going to move to a situation where care is truly personalised, we will also have to think about how we break down the barriers that exist between health and social care. It is particularly important because nobody receives social care for any other reason than they have a health problem which may be either because of physical or mental health issues.

Citizens are understandably confused when they are constantly told that health is free at the point of need, and yet, many people with long-term conditions face having to pay for their own care. This mixed message is the cause of much confusion and leads to tremendous resentment by many citizens who believe that the primary reason they need care and support is because their health is compromised, and yet, this is not funded by the health service.

Much of the Government‘s agenda relies on an integration between health and social care and I believe if we are going to break down the barriers between health and social care, we have to start thinking differently and align our success measures right across the system. I believe the only way to do this effectively is to reclaim the term integration, and to use the customer experience as the criteria of success. In the airline sector there are many different organisations and international jurisdictions which people have to navigate when they take a flight, but as a customer, what I judge this flight on is whether it got me there safely, comfortably and at reasonable cost. These are the success criteria by which I judge an airline, and in order to move the agenda in social care forward, we need to see outcome measures that are firmly focused on the experience of the person who uses the service. All too often the barriers that exist, are made by the system focusing too much on organisations and processes, rather than shifting the focus to people and outcomes.

The barriers that exist in our system have come about because there has been an obsession with certain organisations, to the detriment of the citizens who pay for them. Everyone in the system needs to be focused on the fact they are there to support citizens and that organisations exist to deliver an outcome; they are not an end in themselves.

The NHS has become too focused on its own structure and organisation. What citizens want, is  a good quality services, that meets their needs in a timely fashion, respect their individuality and enable them to live a good life. It does not matter who delivers the services, as long as they transform people’s lives.




“The NHS has become too focused on its own structure and organisation.”

“We need to see outcome measures that are firmly focused on the experience of the person who uses the service.”

Edel Harris





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