This letter from Nick Kempe was published in the Herald on 28th Feb 2024 – we reprint it here with Nick’s permission.
A perfect illustration of how managers of Scotland’s “integrated” health and social care services ignore the impact of the cuts they are imposing (The collapse of social care Letters 27th February) comes from a recent paper to the Edinburgh Integrated Joint Board. In assessing the case for £67m cuts in the city next year it states “Equality and integrated impact assessment. There are no specific implications arising from this report” and “Quality of care. There are no specific implications arising from this report.”
As Duncan MacGillivray observes, we have managers beyond caring and who no longer have any interests in the needs of the people our health and social care services are supposed to serve.
While UK Government imposed austerity and neoliberal philosophy, which asserts everyone is responsible for their own problems, has helped create the new breed of uncaring public service manager, the continued attempts by the Scottish Governments to integrate care with health hasn’t helped. As if the challenge of managing health or social care services was not enough, the Scottish Government now expects managers to do both when Scottish Ministers find it difficult enough to handle one brief. Not only are both social care and health very complex in themselves, broadly speaking they involve very different knowledge, skills and philosophies as the people who use services know only too well. Hence, the medical model of disability and the social model of disability. Combining the two is an impossible job, hence the alienation of senior managers and their rapid turnover in the Health and Social Care Partnerships.
There is little evidence to support the idea that management can force these two systems together and the failures are well documented in Audit Scotland’s reports on “integration”. Despite this, and despite being forced by Cosla in the Verity House agreement to accept that local government should retain some responsibility for care, integration is still at the centre of the Scottish Government’s misconceived plans to create a National Care Service. The latest proposed structure is tripartite and will involve the Scottish Government, the NHS and local authorities running a new version of the Integrated Joint Boards. No mechanisms have been proposed that would ensure these new boards and the senior managers who report to them will be any more accountable than the Edinburgh IJB is now.
If Scotland is to avoid these management failures going forward, we need to empower health and social care staff who are on the front line to speak out about what is really happening. Managers should then be required to support that by giving as much priority to needs as to budgets. Integration undermines possibility that by forcing managers to take responsibility for people and services in which they have little or no expertise. Rather than asking managers to do the impossible, we would be far better keeping care and health separate and resourcing front-line services so they have time to work together as required for the benefit of the people who need them.
Nick Kempe
(Convener Common Weal Care Reform Group)
Another Edinburgh is Possible 