Occupational therapists are ready for challenge of green paper

As Jeremy Hunt outlines principles for social care green paper, the RCOT says OTs are ready for the challenge.

Published on 21st March 2018

Jeremy hunt

Jeremy Hunt has outlined seven key principles that will guide thinking behind the green paper on social care to be published later this year.

The health secretary revealed that quality, whole-person integrated care, control, workforce, supporting families and carers, a sustainable funding model for social care supported by a diverse, vibrant and stable market and security for all would be the seven guiding principles for the adult social care green paper.

Jeremy Hunt said: “The CQC has itself expressed serious concerns about the state of the adult social care market and the risks of provider exit.

“And that pressure is feeding through to the NHS with A&Es becoming overcrowded because hospitals find themselves unable to discharge patients who cannot access social care support packages.

“Behind these systemic issues sit many ordinary human beings in a great deal of distress. Families coming to terms with a relative with dementia. Older people living on their own who won’t admit they are lonely. Care home residents with clinical depression, as we know happens in 4 in 10 cases.

“So let’s be brutally honest. In a country that prides itself on kindness, neighbourliness and respect this does not sit easily, and we need to do better,” he added.

Highest standards of care

While 81% of adult social care providers are good or outstanding according to the CQC, still too many people experience care that is not of the quality we would all want for our parents, Mr Hunt explained. As a result we need a “relentless and unswerving focus” on providing the highest standards of care.

Mr Hunt acknowledged that if you have complex needs, the current health and social care system can be confusing and fragmented. Therefore, the second key principle is the full integration of health and social care centred around the person as when this happens, people stay longer at home, healthier, more independent and needing fewer hospital services.

The third principle of control derives from people wanting to direct the care they receive and have autonomy over decisions. “Control also means transparency and access to reliable information. Where individuals and families have the necessary information to make informed choices, it usually drives quality up,” he added.

Mr Hunt said there was a need to nurture and respect the social care workforce and said it is time to do more to promote social care as a career of choice and to ensure there are better opportunities for progression into areas like nursing which span both the health and social care sectors.

He confirmed that the government would no longer be an ‘NHS 10 year workforce strategy’ – it will be an ‘NHS and social care 10 year workforce strategy’ with the needs of both sectors considered together and fully aligned.

A vibrant, diverse market

The fifth principle is to make the needs of carers central to the new social care strategy. Therefore, if it is possible to make it simpler to look after a loved one, or easier to juggle working and caring responsibilities, encourage volunteering and harnessing new technologies, then that is what should be done, he added.

“A more vibrant and diverse market offer will give people greater choice and more effective support. But it is also vital because if we do nothing to support people’s needs more creatively or efficiently, the cost of simply delivering these services today will double in a decade,” said Mr Hunt, referring to the sixth principle of delivering a sustainable funding model for social care supported by a diverse, vibrant and stable market.

He added that the final principle, which lies at the heart of this debate, is the question of security, acknowledging that the way the current charging system operates is far from fair. Mr Hunt said this is particularly true for families faced with “the randomness and unpredictability of care, and the punitive consequences that can come from developing certain conditions over others”.

“If you develop dementia and require long-term residential care, you are likely to have to use a significant chunk of your savings and the equity in your home to pay for that care. But if you require long-term treatment for cancer you won’t find anything like the same cost.

“So people’s financial wellbeing in old age ends up defined less by their industry and service during their working lives, and more by the lottery of which illness they get. We therefore need a system that includes an element of risk-pooling and, as the Prime Minister promised in the election campaign, we will bring forward ideas as to how to do this alongside their potential costs in the Green Paper.,” added Mr Hunt.

He concluded that innovation would be central to all of these principles and the green paper would not succeed unless the changes embrace the changes in technology and medicine.

Occupational therapists are ready for the challenge

Julia Scott, Chief Executive of the Royal College of Occupational Therapists said: “We wholeheartedly welcome Mr Hunt’s recognition of the need to transform our social care services in order to relieve pressure on the NHS and restore public confidence in the system. We have been calling for a fresh approach for a number of years and continue to gather and present strong evidence of how occupational therapy ensures smooth transitions from health to social care services for the most vulnerable people in society. It is encouraging that Mr Hunt refers specifically to the role occupational therapists play within social care and we wish to assure him occupational therapists are ready, willing and able to take up the challenge to transform services and take a leading role in ensuring his seven principles are converted into meaningful change and an improved offer to our citizens.

“Occupational therapists change the way people view their care; they help patients see care as something they are involved in, rather than something that is done to, or for, them; and changing this perception lies at the heart of social care reform. They are innovative and already delivering care and support in new and different settings and formats in order to ensure people get the help they need and deserve in a timely fashion. Occupational therapists deliver whole-person, integrated care, which supports individuals to feel in control, and their families to feel included. It is occupational therapists that start their conversations with vulnerable people by asking them about their priorities and concerns, an approach determined by the profession’s founding ethos. In addressing barriers to everyday living and wellbeing, occupational therapy ensures people can continue living independently and safely at home, relieving pressure on the NHS, the person and care services. Our professionals lead community social care teams and bridge the gap into health services, an element that will be key to the greater integration of health and social care,” Ms Scott added.

What is missing is funding

Lord Porter, Chairman of the Local Government Association, said the LGA are pleased to see the government’s latest detail on the green paper and while the ‘seven pillars’ of the green paper reflect what the Association has long–called for, the government should resist the temptation for major system reform.

“Councils know what good looks like and, in the Care Act, the sector has legislation that enjoys widespread support and sets out a vision we all aspire to – particularly the emphasis on prevention to help reduce or delay people developing care and support needs. What is missing is the funding to turn that vision into reality.

“While integration is an essential agenda that local government is committed to in order to achieve better health and wellbeing outcomes for people, appropriate funding must be the overriding priority for the green paper and we hope its broad scope will not detract from this focus.

“Government should first make a down-payment on the green paper by injecting additional resources into the system to fund immediate funding pressures which are set to exceed £2 billion by 2020. This will enable the system to stay afloat until such time as the green paper reforms bring in new resources,” added Lord Porter.

Opportunity to address issues facing funding

Margaret Willcox, President of the Association of Directors of Adult Social Services, said: “ADASS will do everything in its power to ensure that this green paper delivers on our shared objectives to deliver person-centred care, and we call on the Government, the NHS, social care providers and all our partners within our sector to do everything they can to do so as well. The millions of people who depend on effective social care are depending on us to seize this opportunity and get this right.

“Those of us in the front line of social care know the quality of our staff and that they have been out in all weathers, working tirelessly in challenging circumstances to make sure that we get the care we need when we are in vulnerable circumstances What they desperately need is for their departments to be adequately funded and resourced so that they can do their jobs. So, whilst it’s positive the Adult Social Care Green Paper will look at the adult social care workforce, we must be clear - the challenges social care teams face are happening to our communities now, and urgent and interim funding is needed to address this shortfall right away.

“It’s also essential we move as a country towards actively planning for social care needs, and tailoring care so that it is centred around the person. We need a system that pro-actively plans with an ageing population for the challenges ahead – which means switching from treating people at hospital when a crisis has developed, to supporting people who need social care and enabling it to allow people to live healthy lives for as long as possible in their homes and communities. It is gratifying to see the Health and Social Care Secretary make moves towards the approach of personalised care budgets, which we have advocated for a number of years. Making the planning and management of health and social care easier for the individual is the key test for any new measures.

“Whilst the moves announced today are key steps in that direction, only adequately resourcing care teams across the country, effective communication and support for both provider and recipients will ensure that they provide the person-centred care that we need. With a social care funding shortfall of over £2 billion by 2020, we must work towards a long-term, sustainable funding solution to make sure that social care goes from being something we don’t like to think about needing to something that we actively plan for. This is an opportunity to address the issues facing social care funding once and for all, and deliver the tailored, person-centred care that we know can make a huge difference to our residents and communities,” she concluded.


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