If our Health and Social Care system is so good, why isn't it working?

“If it’s a good system, why isn’t it working?”

This question should be asked more often in relation to the UK’s Health and Social Care system. Actually, this is the intelligent follow up question, the first and most important question is “what’s the problem we are really trying to solve here?”.

If you asked this question in the context of the national Health and Social Care debate, the answers that would come back from various ‘stakeholders’ (Government, NHS, Care Home Operators, think tanks etc) will all assume and insist, that they know precisely what the problem is and that the answer to the problem should include solving problems such as: funding, staff recruitment, demographics, NHS and Social care integration, funding, fragmented care system, care home infrastructure and err....more funding.

Wrong.

The truth is we are not addressing the problem, I would argue that we are not even 'looking' at the problem. The problem that we are really trying to resolve is that, the UK in the 21st century has a historically unprecedented ageing population and a 19th / 20th Century health and social care system trying to cater for it. Simple. New problem, old tools!

Even if our Health and Social care infrastructure was infinitely scalable and efficient, which it isn’t, we can’t afford it (old age dependency ratios anyone!) or staff it. Yet our leaders, stakeholder groups, round tables, conferences etc have the same conversations about the same solutions, in the same paradigm…….that won’t work, can’t work and are demonstrably not working.

The fact is, if our current system is not coping adequately when we have 3.4 million people in the UK over the age of 80, why the (insert Anglo-Saxon invective of choice here) is it going to work in 2040 when we will have 5.5 million aged 80+? I have not heard anyone pose this question, let alone answer it convincingly!

So, the killer third question is, what is the point of addressing this public health issue with outdated structural solutions that can’t and won't work in the short, medium or long term?

We must think differently, look up from a five year election cycles and admit that current public health policy and our social care infrastructure is flawed and failing. We need to think again.

This is a deeply awkward conversation to have in the UK where the only universally acceptable fetish is the NHS and whose population are, on the whole, ignorant about what the welfare state does and does not provide when you get too old to look after yourself. We also need to be honest about staffing and costs. High acuity Care is hard, very highly skilled, and subsequently like most things that are hard and require skills.....quite expensive.

This is also a subversive conversation in the context of a perverse target culture that regards a hip replacement as a successful outcome, but ‘not needing’ a hip replacement in the first place, as irrelevant. Worst of all this dishonest and closed mindset lacks empathy about what it really means to condemn millions of people to an old age of uncertainty, possible impoverishment, loneliness and all too often, misery.

Of course, there is no ‘silver bullet’ here (outside of honesty!) but one of the answers to the problem that we really face as a society is the Housing with Care model. It’s preventative, is desirable (not for everyone…but certainly for some) It’s a policy mechanism that free’s up unoccupied family homes, it’s social, it’s an extremely efficient way to deliver care to large numbers of people and, best of all, it’s affordable for large swathes of the population with the right business model and compliance standards.

At ARCO we and our Members and Partners are huge advocates for this model, we are a movement as much as we are an industry. We are one of the few 'oven ready' answers to the questions we really should be asking ourselves but we are not asking ourselves smart questions we are repeating what is convenient and therefore the only repeat answer to the wrong question is give the NHS more money! Its a vote winner after all!

The truthful best answer? Try and keep the ageing population out of and away from the NHS as much as is possible by getting as high a percentage of them (by which I mean 5-10%) into Housing with Care where appropriate! After all, an operation in Hospital might be a measurable (but expensive) outcome, but prevention is a much better (and cheaper) cure.