In January, five independent commissioners began the task of tackling the largest challenge faced by the people of Essex since the 1960s − how will we care for ourselves and our communities now and in future? Sir Thomas Hughes-Hallett, who led the commission, discusses some of the points its report raised
During the Who Will Care? commission’s consultation process, I met Madison and her mother in Canvey Island this summer. They were the first to volunteer to keep an eye out in their community for those who might need care and support − part of a local charity’s campaign to promote little acts of kindness.
This was second nature to them: they already dropped in on a frail neighbour − making tea, running errands, lending him money to tide him over if his benefits were late.
‘No one understood who did what or paid for what, and what we as citizens could expect to receive having paid our taxes’
To professionals this is demand management, and shows the system benefits of keeping potential service users upstream. To Madison’s mother it was being a good neighbour.
Madison and her mother were typical of the evidence we heard from people across Essex during the commission.
Essex County Council asked me to undertake the work looking at solutions to prevent a future crisis in health and social care in Essex, but I was clear that we had to look beyond the local authority business of social care and toward a much wider and increasingly complex care system. And if the problem is shared then the system must also jointly own solutions.
Of course, a “system” suggests coherence. In fact, no one understood who did what or paid for what, and what we as citizens could expect to receive having paid our taxes. This confusion means we typically find ourselves considering care when we, or those we care for, are at a point of crisis.
What also stood out was frustration at misaligned incentives − one senior health official suggested the system had a “hint of madness running through it”; others of resignation at being incentivised into turf wars with different parts of the care economy. Integration of course helps, but is an organisational response to a structural problem.
Contemplating care against a backdrop of demographic pressure and straitened finances could have been a depressing task: it was anything but. Essex residents − including those that professionals would assess as “vulnerable” − recognised the challenge facing the public sector in an age of austerity and show much greater resilience than professionals might think.
A new mantra
The people of Essex were frequently more radical in their thinking than those providing services on their behalf. When we asked 100 members of the public to create a care budget for Essex, they recognised the critical importance of preventative services, community services and social care and invested more in these to keep more people out of costly hospital settings.
‘If we want a health and care system that works, we must have clear leadership, vision and accountability from within and beyond public services’
The commission proposes high impact solutions to prevent a future crisis in care. We call for better use of data and technology and a focus on embedding prevention, grounded in the belief that planning of our care must involve people as well as professionals.
If we want a health and care system that works, we must have clear leadership, vision and accountability from within and beyond public services, and a greater role for communities and individuals.
If this Essex mantra of “care, care, care” could replace the orthodoxy of “NHS, NHS, NHS” we would all benefit. Until it does, if we want to live and age in a society that does care, we should hope there are more people like Madison and her mother.
Sir Thomas Hughes-Hallett chaired the Who Will Care? commission into health and social care strategy. He is chair of the Global Institute for Health Innovation at Imperial College, University of London, aformer chief executive of Marie Curie Cancer Care