HSJ’s must read stories and talking points from Thursday

The care conundrum

It’s been clear for many a year that a big funding system overhaul is needed to ensure older people can get the care and support they need, in a fair way. The issue has been avoided time and again, being much too difficult for politics, and probably the public, to get its head around.

Entirely understandable, then, that much of the response from readers to our revelation on Wednesday that the prime minister has set up a review to look at matters of care funding and policy has been along the lines: “Can kicked down the road. Predictable political response.”

Partly there is irritation the government isn’t acting now, when pressures are severe.

There will also be suspicion about the vague and widely defined terms of the work – some have noted the danger of looking at “integration” as the solution. “You can’t cut money out of social care and then the NHS and then hope that integration will solve all your problems,” says one HSJ reader.

Integration will indeed be a feature of the review – and today we report on the next steps, from the government’s point of view, towards bringing the health and care systems together “by 2020”. Areas will be invited to apply to “graduate” from the better care fund this year but only a handful are expected to be judged ready for adulthood.

It is very unclear how this process will deliver the government’s declared integration aspirations – surely one of the starting points for the Cabinet Office review.

These issues and more are discussed in the latest instalment of our Commissioner expert briefing.

DH looks into unregulated staff ‘blacklist’

The Department of Health is exploring how it can protect patients from harm caused by unregulated staff in the NHS and could potentially consider introducing new powers to allow them to “blacklist” some workers.

HSJ has learned that civil servants have been exploring the idea and asked the Professional Standards Authority to draw up advice to the health secretary. It stressed that no formal decision had been made.

Under “prohibition orders”, healthcare assistants, physician assistants and other care staff could be prevented from working if they are found guilty of significant misconduct that would likely have to be set down in legislation.

The issue of regulation for care assistants has been a persistent one in recent years following the Mid Staffs scandal. Sir Robert Francis QC recommended HCAs be registered as a step towards full regulation but the government backed away from this.

HCAs remain unregulated with no mandatory training requirements in place.

The PSA told the DH prohibition orders would be an effective way to “deal with severe cases of misconduct and remove those that may be a danger to the public”.

It said such an approach could boost public confidence and cover multiple groups of staff and would likely be less costly and complex than full regulation. However, it also warned the idea was unlikely to “foster professionalism in any meaningful way” and could have a negative impact on workforce morale.