Understandably public interest has been focused on the role of their GP and the effective further privatisation of the NHS. There are however serious threats to that second part of the Bill (Social Care) often seen as the Cinderella service and poor relation to Health, that are outlined here to redress the imbalance of current media coverage of this potentially disastrous Bill.
By way of introduction though the key aims of this Bill are as follows:
1/ The role of the GP is set to change under the coalition by giving new consortiums of GPs across England the task of commissioning the healthcare they deem appropriate for their patients, and control over the budget – £80bn – to pay for that.
2/ To make the NHS more accountable to patients and the public by establishing Healthwatch, a new independent body that can look into complaints and scrutinise the performance of local health providers.
3/ To compel all hospitals in England to become foundation trust hospitals – that is, semi-independent of Whitehall control with, for example, the freedom to earn money by treating certain numbers of private patients. (Around half already have that status. Growing numbers have acquired Foundation Trust status since Tony Blair introducing the concept)
4/ To improve public health by establishing a new body, called Public Health England, to improve public health and reduce health inequalities between the richest and poorest.
5/ To cut the bureaucracy of the NHS by abolishing the 150 or so primary care trusts (PCTs) and 10 strategic health authorities by 2013, slashing NHS management costs by 45%, and reducing the number of arm's length bodies, or quangos, such as the Health Protection Agency and Human Fertilisation and Embryology Authority.
Much of the furore has been centred on opposition to the Bill by GPs themselves and the increasing number of Lib Dem MPs and supporters who fear the inevitable delays in care for patients as GPs and surgeons undertake bureaucratic tasks for which they are neither trained nor qualified.
The British Medical Association, at a special conference just days after Liberal Democrat delegates registered their own unhappiness with the measures at their spring conference, attacked large portions of the legislation as “ill-thought-out”, “implemented in a rush”, “contradictory”, “driven by ideology not evidence in a major economic downturn” and called for “evolution, not revolution”. David Cameron has dismissed the BMA’s concerns as those of ‘just another trade union’ resisting public sector reform.
The MP for Southport, John Pugh, (in my own Borough), who has towed more lines that a tugboat out of the Mersey, and is the backbench Liberal Democrat health spokesman, was blunt in the Commons debate, saying: "It is blindingly obvious that the health and social care bill is in trouble. It is not necessary to hang around the lobbies much to see that a corrosive unease is spreading through government ranks even in the most unlikely quarters and to see how opposition hardens with every defiant unbending rebuttal from the Richmond House bunker."
Pugh warned of "a potential shipwreck if costs over-run, if productivity falls, if hospitals close, if waiting lists grow, if morale declines or if the NHS appears to be denatured, privatised and not safe in our hands".
Pugh and others however, have missed the opportunity to identify risks that that UNISON has for several years championed: – real risks to vulnerable people trying to remain in their homes and real risks to the staff charged with the responsibility of providing residential, domiciliary and day care alternatives. This is the part of the Bill that ‘shadow’ opposition has lived down to its name (shadow) and been almost invisible and a mere reflection of its counterpart.
The Kings Fund has identified the likely shortfall in cash for Social Care of up to £1.2bn up to 2014:
http://www.bbc.co.uk/news/mobile/health-12758282
For service users this will mean:
· an even greater challenge to receive frontline, preventative services that enable them to keep out of hospital and live at home.
· More of them will spend more time injured on the floor having fallen at home
· More service users will be admitted to hospital as an emergency and spend longer there as options for discharge reduce
· more of them will die at home unsupported living in poverty and squalor
For frontline Social Care Workers, the majority of whom are low paid, part-time women the consequences are significant. Their work will become entirely focused on service users who are ‘in crisis’. There will be no room for proactive and preventative social care practice. They will face increased threats of violence from frustrated family members and carers who will be refused services on an increasing basis.
They will need to take more life and death decisions than ever before and they may well face increased criticism from a reducing police force called upon more often to break in to houses to check on service users. They will become frontline rationers of increasingly scarce resources and work-related stress will rocket accompanied by increasing inability to retain properly trained and paid staff. The competitive race to the bottom will force long serving staff out and bring private companies in who have profit motives and high staff turnover.
The risk of staff and agencies being prosecuted will rise dramatically as more service users die or are seriously injured at home as a result of ‘slips trips and falls’. The ongoing challenge from private agencies seeking to use the current economic situation to drive down terms pay and conditions of our members will impact upon the calibre of the staff required to provide a much altered and high risk service.
UNISON has long campaigned for joined up thinking and working between Health and Social Care, but this Bill will drive a wedge between those at the cutting edge of frontline protection of vulnerable people living at home. Throw into the mix the ‘Personalisation’ agenda and ‘direct payments’ and we have an even less regulated, less trained, less secure workforce expected by our communities to keep our vulnerable residents safe in greater numbers and to a greater degree.
Maybe if the challenge faced by the ‘Social’ element of the Health and Social Care Bill was given equal prominence to that of ‘Health’ the potential social disaster that is contained within this Bill would receive even broader condemnation. It is ironic that the largest voting proportion of the electorate (older people) faces the largest threat as a result of this bill and yet seems to be given the least consideration. The staff who deliver these services are given even less attention – that is why UNISON consistently raises these issues on their behalf.
Representing 300,000 members in social care and over 40,000 social workers, UNISON has teamed up with Community Care – have a look at communitycare.co.uk/unison (member discount code is UNISON).
Also check out up-to-date social care issues at www.unison.org.uk/socialwork
Glen Williams,
National Social Care Forum – Sefton LG Branch