an old blog but why BCF is worth a punt
Three things I want to focus on in this blog.
First, I went out on my lovely new road bike – she is truly great (a specialized dolce sport), this is my new form of cycling. I’m a good cyclist, in fact a fairly competent cyclist but never on a road racing bike before. So, we are still getting used to our new relationship, each other and this new balancing act of working together. It’s been going ok so far. Today started off like that, then, out of nowhere I hit a bump and crash on the floor toes still stuck in the silly pedals. Why do they have those pedals? Why do I have those pedals?
I grazed my knee and now I’m abit sore, bike still looks good (big relief) small graze on handlebars only evidence. A few miles still from home, what did I do? Well I got back on and road her home. Apprehensive and more uncomfortable than usual with a scraped knee and ripped lycra leggings. Will I stop riding? No, I am enjoying the challenge and I love cycling. But, I have to admit I am in a new way of working with “miss road racing bike” and we will probably hit a few more bumps, gravel and uneven surfaces before we fit together. I want to make this work though and even though it’s optional, I am determined to keep at it.
Second thing that occurred today is the Better Care Fund got some publicity suggesting in national media that Whitehall were calling a halt to the transfer of NHS funding to local government. Therefore implying Ministers getting cold feed with integration. The Better Care Fund will be the vehicle to transfer £3.8b of NHS money to local government from 2015. It’s to be spent on furthering joining up of health and social care services thus prevent older people and other vulnerable groups ending up in A& E and acute beds in hospital. The money is to be spent as part of a joint commissioning plan in each area on evidenced based models of community support. It has a challenging target associated with it of needing to reduce unplanned demand for acute care by up to 15%. Tough ask and harder than getting used to a new road bike I fear.
The BCF hit their own bump and the aspiration and necessity of developing integrated health and social care services for our population (particularly the elderly and most vulnerable) got a few grazes today. There will be a large number in the NHS secretly glad that the BCF may have come off its bike. As they see money as belonging to the NHS and needing to be spent on only NHS services. Truth is that the BCF is still going ahead, but it needs more work on the detail of the plans behind it, more work on managing risk and I agree with the Kings Fund it needs a transition fund set aside or current provision will implode while we build the new. Another big risk is that providers have not been well engaged by commissioners to date and they have the most to lose here if not won over to the benefits of integrated care that is supported by industrialised 24/7 primary care.
So I sat with Ice on my sore knee reflecting on what happened, what went wrong and could I have avoided the crash. I remembered my neighbour, retired and a very good road cyclist saying when I saw him with my new bike “you will fall off that at least 3 times you know, everyone does.”
There is a risk here that those who want to hold onto the status quo will convince Ministers it’s too risky to progress with joining up health and social care and more beds and more specialised acute care is the answer. Meanwhile, they will advise let’s take a breather as all this talk of integration is too hasty and too poorly thought through. They won’t want us to try this new way of working with “miss road racing BCF.” Of course to proceed is not without risk and we will probably hit a few more bumps along the journey and fall over a few times too.
Unfortunately the current state of services is not fit for now or the future, and is not without risk of a road crash. Health and social care in many areas still provide separate services with different assessment processes and spend endless time arguing about who pays for what services. Mental health services are on the edge of a major crisis, Winterbourne did not stop the institutionalising of more and more people with learning disability. The NHS is not fit to care in hospital for people with complex health and social needs and people themselves don’t want to be in hospital either. As the full force of austerity hits the most vulnerable in society combined with our aging population something will give.
Too many examples abound on social media and even BBC Panorama and Protecting our Parents show Individuals and their carers becoming exasperated when they need care that supports their long term condition and keeps them independent. More often than not 4 visits from social care and some community nursing is the most we can get you. Wanting a simple, 24 hour, joined up system that gives us and our elders support to stay at home however frail we are, is all we ask.
The reliance on acute care is not the answer either or just more money added to NHS to fund more of that. As more hospital beds will beget more beds and lead to more cost with poorer outcomes for the most vulnerable. Acute care is fabulous for those who require high tech, high spec, highly skilled acute interventions but it is the worst place to be if you need ongoing support to manage a long term condition. Care needs to maximise the independence of the individual and the natural resources of the family and wider community.
This isn’t going to get better without effort and real change. The Better Care Fund is one of those levers, but it needs help and support and careful implementation everywhere. Numbers of over 65s will increase by 65% in the next 25 years, by 2030 we will have 3 million childless elders and 50% of those currently over 60 already live with a chronic long term condition. It is clear that the current models of care are not sustainable so let’s not dismiss the BCF, let’s help it succeed.
So finally, I sat there with my sore and bleeding knee and on the radio came David Soul a cheesy crooner from 1977 singing “don’t give up on us baby”
Don’t give up on us baby, don’t make the wrong seem right
The future isn’t just for the night, it’s written in the moonlight
And painted on the stars, we can’t change us…..
Don’t give up on us baby, we’re still worth one more try
I know we put the last one by, just for the rainy evening
When maybe stars are few, don’t give up on us I know
We can still come through
I believe passionately, and the evidence is mounting that the only answer to the challenges our aging population faces is integrated care. Care that is coproduced with the recipient and their family. Get back on that bike, get a few scrapes and don’t give up on us baby.