After the Government announced how it will be funding its major reforms of Health and Social Care through a 1.25 per cent tax levy, Dr Philippa Whitford argues that the reforms package, in the form of the Health and Care Bill, does not do enough when it comes to social care, in particular with regards to the training and provision of social care workers.

The last Health and Social Care Act, of 2012, is what got me actively involved in politics, as I followed the Lansley proposals in sheer disbelief that anyone could think breaking the NHS in England into pieces, and making them compete with each other, would somehow improve patient care!

Less than a decade on, this Conservative Government is having to unpick some of the worst aspects of that legislation which led to fragmentation of the NHS in England.

While many will be glad to see the back of Section 75, which forced health service contracts to be put out to tender, the Government's Covid response doesn't suggest they are any less keen on outsourcing services to commercial companies.

Health & Social Care require a collaborative approach to developing integrated services which are wrapped around the patient, and their family. However, instead of the Integrated Care Systems and Partnerships being statutory public bodies, focused on improving the health and wellbeing of their local population, conflicts of interest will be created by private companies, hoping to win contracts, being able to sit on Integrated Care Partnership Boards.

The wasteful transactional costs of the purchaser/provider split and financial competition will remain, as the UK Government has failed to take the opportunity to return to a publicly funded and delivered health service as we have in Scotland.

This Government is, unfortunately, still wedded to the flawed idea that financial competition drives up the quality of clinical care, despite the lack of any evidence. Rather they should recognise the need for service integration, along with a relentless focus on patient safety and clinical outcome audits, as highlighted in the Nuffield Trust's 2017 report 'Learning from Scotland's NHS'.

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The gaping hole in the misnamed Health and Care Bill is, of course, the complete lack of any proposals to close the funding gap and improve the delivery of Social Care.

In 2015, NHS England's Five Year Forward plan already identified the dependence of the NHS on a well functioning and resilient Social Care sector and, during the 2019 election, the Prime Minister claimed to have a fully prepared Social Care plan. However, it has yet to see the light of day!

The failure to properly fund Social Care in England will undermine the whole integration agenda – as healthcare providers are unlikely to be willing to share financial risk with woefully underfunded services. Not only has the pandemic highlighted the vulnerability of the Social Care sector, particularly care homes, it has also brought home the important role played by care staff.

In Scotland, where care staff are already registered and paid at least the real living wage, the Feeley Review from earlier this year proposes the further development of the profession and the establishment of a National Care Service with Scotland-wide services standards, training programs and terms and conditions. While Scotland is unique in providing free personal care, the review proposes taking a human rights approach to the provision of care support: valuing it as enabling individual participation in society rather than just a financial burden.

Over the coming decades the UK population will age considerably and it is critical to have services in place to meet the needs of older citizens. However, we also need a greater focus on healthy ageing as, while life expectancy has increased, we are not yet ageing well and this is exacerbated by significant health inequalities between those living in affluent or deprived communities.

Indeed, poverty is the biggest single driver of ill-health and laying the foundation of healthy ageing means tackling child poverty and investing in the wellbeing and early years of our younger citizens.

Wellbeing is not about healthcare, and is more than just an absence of physical or mental illness, but developing a 'Wellbeing' economy would require a total change in philosophy. While the public are looking for a radical approach to post-Covid recovery, it is not clear this UK Government are interested in taking up the challenge!

We will be the next generation of care users, whether as recipients of care or as unpaid carers seeking respite for a loved one. We, therefore, have a vested interest in improving Social Care provision but that will require investment in training, supporting and rewarding those we rely on to deliver that care.

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