Our health and social care system has been pushed to its limits in the current crisis. We shouldn’t aim to just ‘go back to normal’.
We need to learn from the pandemic. Both the good – using new technology, a bigger role for community groups, and the bad – the separation of health and social care, continuing health inequalities.
We know that there is a desire for change. Just 5% of health and social care leaders we surveyed thought that the system was entirely fit for purpose. And in our poll of the public, 66% wanted to see social care change to allow more people to stay in their homes. A quarter wanted more say over the health and social care support they accessed.
Our new report Reimagining the future of health and social care explores ways to make this change happen, and different scenarios for the future of health and social care.
To meet the demand for change, we are calling for a People’s Health and Social Care Commission. This would be a group to allow citizen participation in moving towards a system that brings health and social care together into a system that is resilient, responsive, equitable, and caring.
Opportunities for change
At the RSA, we’ve been exploring both the future of health and social care and how change happens since before Covid-19. Based on this, it seems that the 3 conditions for change – desire for change, events that create momentum, ways to embed change – have been met for health and social care in the UK.
We have seen some positive examples of change during Covid-19:
- The surge in the use of technology in health care over this period, from text alerts to video consultations.
- Increasing community and ‘place-based’ activity. During the crisis, health and social care has grown beyond formal provision to ‘whole-place’ responses. We’ve learned what can be achieved if places are involved in determining what they need.
- New ways of working within the system (like self-managing teams) have displayed greater autonomy in care provision, overcoming challenges in staffing.
SCENARIOS FOR THE FUTURE OF HEALTH AND SOCIAL CARE
The future of health and social care will depend on the extent to which we seize these opportunities for change. In our new report, we set out three scenarios for the future of health and social care:
In our Pandemic NHS future, all health and social care activities are pivoted to ensure that as and when another pandemic – or indeed a second wave of the current crisis – hits, the NHS can respond effectively and efficiently.
Technology is embedded to support data collection and analytics about the spread of disease and the vulnerabilities of citizens. Latent capacity is built into the NHS to ensure that it can support increased demand.
This future builds in resilience and responsiveness, but risks stretching inequalities in general provision.
In our System Statis future, returning our health and social care system to normal is the critical activity.
Responding to public demand, increased funding is injected to support the recovery, but this is not matched with systemic change.
Instead, the NHS works through the backlog of routine appointments, procedures and treatments missed during this period.
In our Care Horizon future, a greater period of reflection and review of what happened during the pandemic leads to far greater integration between health and social care.
Lessons are learned from the intrinsic link revealed between health and social care and the systems become more intertwined. The care horizon prioritises a connected health and social care system, and in turn moves towards whole person, whole place care.
A People’s Health and Social Care Commission
Clearly, this is a critical moment for the provision of health and social care.
We should reflect on the lessons from the Covid-19 crisis, but it is also essential that we consider how to overcome existing challenges in the system.
To create system change that supports all citizens, we recommend a People’s Health and Social Care Commission. This would make sure large-scale change is people-led.
Underpinning such a commission will be the values a new system must seek to embed: resilience, responsiveness, connectedness, care and equity.
As a country, we came together to respond to Covid-19. This plan should engage widely so that we can collectively own the future of our health and care, to prepare us to face the long-term challenges of the next decade.
Deep structural weaknesses have left more vulnerable people and places exposed for some time; now these weaknesses are visible to all.
Ken Loach’s new film shows that social care workers still care, even when the system doesn’t. Have we lost sight of the difference between delivering a package and delivering care?