Archive for the 'Health' Category

It’s not just about the money: 5 dilemmas underpinning health and social care reform

Following on from the publication of the third edition of Understanding health and social care, Jon Glasby looks at what’s needed for long-term, successful health and social care reform.


Jon Glasby

Open any national newspaper or turn on the news and (Trump and Brexit aside) there is likely to be coverage of the intense pressures facing the NHS.

Throughout the winter, there have been stories of hospitals at breaking point, an ambulance service struggling to cope, major problems in general practice and significant financial challenges.

For many commentators, this is one of the significant crises the NHS has faced for many years, and quite possibly the longest period of sustained disinvestment in its history.

“Draconian funding cuts have decimated services at the very time that need is increasing.”

In adult social care, the situation is even worse. Draconian funding cuts have decimated services at the very time that need is increasing with an ageing population, a rise in the number of people with multiple long-term conditions and growing numbers of young people surviving into adulthood with complex needs.

Increasingly, NHS leaders have argued that if any extra money is to be found, it should go to adult social care – otherwise the system as a whole could simply clog 1280px-nhs_nnuh_entranceup, fall over and fail.

However, we can’t keep doing more of the same. Health and social care provision must align with how we live other aspects of our lives in the 21st century.

While we need a funding settlement which gives some certainty for the future, we also need to address the underlying tensions that continue to dominate many of our services.

As explained in the new edition of Understanding health and social care, five key dilemmas are:

1. How best to promote more joined-up responses to need in a system that continues to assume that it is possible to distinguish between people who are ‘sick’ and those who are ‘frail and disabled’.

2. Whether to support people with long-term conditions because they are citizens with a right to independent living, or simply as a means of reducing reliance on expensive hospital services.

3. Whether to focus on challenging discrimination in health and social care or in wider society, and whether to do so via specialist initiatives or via general approaches.

4. Whether to involve people with experience of using services because they are ‘customers’ who can help improve the ‘product’ or because they are citizens with a right to greater choice and control.

5. Whether to support carers because they run the risk of being exploited by formal services and deserve the same access to a meaningful and stimulating life as everyone else, or because this is a cheap way of helping the ‘service user’ and reducing demands on formal services.

In the short term, it is probably possible to do a little of each of these ‘either-ors’ – to promote partnership in a system that is deeply divided; to tackle discrimination in formal services and in wider society; and to support people with long-term conditions, involve service users and support carers for a mixture of (not necessarily compatible) motives.

In the long run, however, the jury must remain out on the extent to which the current system can continue to contain these contradictions and tensions.

The second edition of Understanding health and social care appeared part-way through the Coalition government of 2010-15, asking whether massive public spending cuts and an uncertain economic outlook would lead to radical new ways of working in health and social care.

“Evidence of genuine and long-lasting reform still seems lacking.”

The third edition now appears under a Conservative government, when the full force of these cuts is being felt, and when austerity is feeling to many like a long-term state of affairs.

east_midlands_ambulance_service_nhs_trustEvidence of genuine and long-lasting reform still seems lacking.

Government remains committed in principle to further joint working between health and social care, but not to removing the underlying distinction between free health care and means-tested social care altogether.

There is talk of greater choice and control, but a very real risk of simply co-opting this language and creating little more than ‘zombie personalisation’ (a phrase coined by leading personalisation expert, Simon Duffy).

Discrimination remains widespread, the focus is often on ‘user involvement’ rather than on human rights, and support for carers continues to evolve but with longstanding and significant barriers remaining.

“Every problem can also be an opportunity.”

Choices still need to be made, but, in the meantime, every problem can also be an opportunity.

For example, the current policy rhetoric around ‘integrated care’ is a helpful hook for local partners keen to promote more effective joint working, while the personalisation agenda could still be transformative if we could implement it in a way that is true to its original values and ideals.

The Equality Act gives significant scope to take positive action to promote equality (not just avoid discrimination), while the importance of user involvement and the need to support carers are now so widely recognised that the genie feels well and truly out of the bottle.

Understanding Health and Social Care helps to explain these opportunities and tensions, thus supporting students and practitioners to change future practice and attitudes for the better, whatever the choices made by those at the helm.

Jon Glasby
School of Social Policy
University of Birmingham
February 2017


understanding-health-and-social-care-3rd-fcUnderstanding health and social care by Jon Glasby can be ordered here for £17.59.

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Get social care right and the NHS will benefit

How can we improve access to and quality of social care? Catherine Needham, co-author of Micro-enterprise and personalisation, discusses how micro-enterprises and micro providers could improve care services. 


Catherine Needham

At a time when the Red Cross is warning of a ‘Humanitarian Crisis’ in the NHS, there is a growing recognition that pressure on NHS services will not be alleviated unless we get social care right.

Social care services support frail older people and people with disabilities. They are run by local government and have borne the brunt of the local authority cuts in recent years, with around 26 per cent fewer people now getting help than did in the past.

Many care providers have gone bust due to downward pressures on fees and in many parts of the country it is very hard to recruit trained staff to work in care when the pay rates are higher at the local supermarket.

“It is very hard to recruit trained staff to work in care when the pay rates are higher at the local supermarket.”

Together these pressures contribute to older people being stuck in hospitals, unable to be discharged into the community because the support is not available to them.

Fixing social care

Getting social care right is not a quick fix. Access to good quality, affordable care for people with disabilities and older people is a challenging issue.

Continue reading ‘Get social care right and the NHS will benefit’

Where you live can kill you

Clare Bambra’s book Health Divides: where you live can kill you, published by Policy Press today reveals shocking facts about the social, environmental, economic and political causes of these health inequalities. In today’s guest blog Bambra shares her insights on how location really is a matter of life and death…

Clare Bambra

Clare Bambra

In 1842, the English social reformer Edwin Chadwick documented a 30-year discrepancy between the life expectancy of men in the poorest social classes and the gentry.

He also found a North-South health divide with people from all social classes faring better in the rural South than in the industrial North.

Today, these inequalities persist.People in the most affluent areas of the United Kingdom, such as Kensington and Chelsea, can expect to live 14 years longer than that those in the poorest areas, such as Glasgow or Blackpool.

Men and women in the North of England will, on average die 2 years earlier than those in the South. Scottish people also suffer a health penalty with the highest mortality rates in Western Europe. Continue reading ‘Where you live can kill you’

10 things you should know about foodbanks

hunger-pains-fc-4webThink you know about foodbanks and the people who use them? Think again.

Kayleigh Garthwaite’s book , Hunger Pains, challenges some of the biggest foodbank myths.

Here are the top 10…

1. Anyone can turn up and get a food parcel

You need a red voucher to get food, given to you by a frontline care professional who has identified you as being in need. It is likely that many people in food poverty who are outside of the ‘system’ aren’t getting help.

If somebody does come in and say “Can I have some food?” you can say “Have you got a voucher?” as that’s the rules.” Foodbank volunteer

Continue reading ’10 things you should know about foodbanks’

Beyond Downton: Can the welfare state embrace a participatory future? #participatorycare #allourwelfare

The union of personal experience and professional knowledge has informed Peter Beresford’s latest book All our welfare which publishes today. In his guest post he reflects on a life lived in parallel with the development of the welfare state and suggests greater involvement of participants in the process of welfare could be the key to an enduring future…

Beresford imageWriting All Our Welfare has really made me realize just how much the welfare state has impacted on my life – personally as well as professionally.

At a time when we are encouraged to think of ‘welfare’ as for ‘other’ people, particularly stigmatized and devalued other people, this goes against the grain of received wisdom.

I realize that I may have had more contact than most people, with state services – including so-called heavy end ones, like ‘benefits’, psychiatric system, environmental health, rent officers and so on. But this increasingly feels like a strength rather than a weakness in exploring social policy.

Lived experience

I wanted my book to include and value lived experience as well as traditional ‘expert’ knowledge. As part of this I included comments from many members of my family in the book. What was interesting was that all of them could speak from direct experience about the welfare state, from age three to 91 and most did so enthusiastically (Charlie (aged 11) and Poppy (aged 9) weren’t too keen on some aspects of school!).
Continue reading ‘Beyond Downton: Can the welfare state embrace a participatory future? #participatorycare #allourwelfare’

5 free articles on the impact of alcohol

bottlesThe season of excess is over and many of us are saying ‘cheers’ to booze – at least for the month of ‘Dry January‘ – whether to save pounds, lbs or our livers.

In terms of health, new guidelines issued by the Chief Medical Officer Dame Sally Davies suggests there is no such thing as a ‘safe’ level of drinking and that we should look to replace a glass of wine or beer after work with an alternative such as tea.

Alcohol consumption continues to be a much debated subject both at a policy level and within the media. Concerns over industry lobbying in UK alcohol policy, how alcohol is priced and the extent to which evidence is used (and how) in forming policy and practice are items that have been discussed in our journals.

From a more personal perspective how do you talk to your children about grandparents or other close relatives who have a problem with alcohol? And how does our experience of alcohol in our environment as children affect us as we become adults and parents ourselves? Fascinating research on both those topics is covered in Families, Relationships and Societies.

So, with a cuppa in hand, we invite you to read some sobering research on the wider political and personal impacts of alcohol in our society… Continue reading ‘5 free articles on the impact of alcohol’

An Unhappy NHS – Taking the Long View

Today’s guest blogger and author of The Health Debate, now in its second edition, David Hunter, tells us why we need to dig deeper to understand and change the chronic unhappiness in the NHS…

David HunterAs it enters 2016, the NHS is not a happy organisation. It hasn’t been for some time but the problems and pressures that have gathered pace through 2015 are coming to a head.

A threatened strike by junior doctors is already a firm possibility but other issues are mounting by the day, ranging from cash‐strapped hospitals, allegedly underperforming GPs, shortages of clinical and nursing staff, poorly integrated health and social care, non‐existent or threadbare mental health services, the persistence of a bullying culture, to unforeseen cuts in public health funding that threaten to put further pressure on an already over‐stretched NHS. The list goes on.

The quick fix

It is tempting to pick these issues off one by one, reaching for the quick fix while also finding someone to blame for allowing things to reach such a parlous state. That would be a mistake and would fail to understand the forces that have brought the NHS to where it is today.

Taking the long view is a necessary prerequisite to finding appropriate solutions. Continue reading ‘An Unhappy NHS – Taking the Long View’

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