Hope, Challenge and Change in Adult Social Care
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ADASS President Melanie Williams reflects on the relationship between social care and the NHS at the King’s Fund Annual Conference 2024.
A labour of love, wrecking ball, don’t stop believing are titles to three great songs. Last week however, they took on a new meaning for me as speakers at the King’s Fund Annual Conference were challenged to name a song title to describe the unique relationship between the NHS and social care.
We will come back to my choices, but I started my talk by reminding the audience of the myriad of interactions that take place every day between millions of people working across health and social care.
Let us start for instance with a social worker and nurse deciding how best to support an older prisoner serving a life sentence with their personal care needs. Another example is of an approved mental health practitioner and a section twelve approved doctor deciding if a person experiencing a mental health crisis can be supported at home or needs to be detained under the mental health act.
There may be a care worker and a paramedic talking to a family about whether their parent can be safely treated at home for end-of-life care or two commissioning managers working with a carers group to agree a new carers strategy.
Another one of these interactions could include, an adult safeguarding board considering the learning from a safeguarding adult review where a young adult who has experienced care had taken their life.
During these relationships, interactions, and sometimes disputes, we will feel that we can absolutely focus on what is right for our people, whether that is an individual or our whole population. However, the ideology of partnership and integration can be severely tested when we are protecting our scarce resources or feel very clear about what we think is the best solution and others do not share that point of view. This is when we can feel mistrusted, blamed, dumped on and misunderstood.
The theme of the King’s Fund Annual conference was hope, challenge and change. The hope is not only that on many occasions these relationships and interactions work well despite the picture that we found in our annual survey – increasing pressure on adult social care budgets due to NHS pressures, CHC decisions being reviewed and overturned, DASS reporting a variation in their influence in their local Integrated Care Systems. But there is also hope in the findings of the Darzi review, which underlined the urgent need to address social care to fix the broken NHS.
He makes the argument – as ADASS and our colleagues across the sector have been doing for years – that accessible and personalised adult social care is key if we are to successfully shift to a neighbourhood health model. And although there has been little mention of social care directly in their recent speeches, the Prime Minister, Sir Keir Starmer and Secretary of State for Health and Social Care, Wes Streeting have repeated the message that reform will happen and there will be a move to community support.
Let me return to those song titles. Yes, working in health and social care can feel like a ‘labour of love’, but we ‘won’t stop believing’ that the National Care Service and Fair pay agreement will deliver the reform we need into the long term. What we do need is urgent action to stop the ‘wrecking ball’ from knocking social care over to enable us to deliver short term gains in prevention and community care that enable people to live healthier gloriously ordinary lives.
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