Why don’t government departments communicate? I thought it must only be a case of walking down the corridor, but then of course I am out of date – any communication will surely be done by computer!
I suppose it would be almost treason to have regular meetings with different departments to enable everyone to be aware of newly proposed policies/procedures and their impact?!
This, of course, is particularly relevant to health and community services. Did I have a wonderful dream that health services and social care were to be integrated to make seamless services for those at their most vulnerable? Did I dream that at a local level there would be full co-operation between local CCG’s and local authorities? There was this ‘fantasy’ about ‘integrated care’.
Two very quick examples.
Firstly, NHS England has issued its usual winter warnings for keeping healthy. Now, there is nothing new here: Don’t forget to have your flu jab (have you had yours yet? If not – why not?); wear layers of clothes; ensure at least one room is heated; be active – exercise keeps your circulation going and helps prevent you getting cold to the marrow; and of course HAVE A HOT MEAL A DAY.
All very sensible you may think, but – there’s always a but – many older people cannot get a hot meal a day, especially if they are housebound. Why? Because fewer than half the councils in England provide a hot meal through the meals on wheels scheme now. Two years ago 2/3rds of councils were offering meals on wheels – now it has dropped to half and continues to plummet.
Why do councils think they can do away with this vital resource? Simply because it is not a statutory obligation and councils need to concentrate on their statutory duties – especially with the continuing cuts to their budgets.
However, is saving money really a sensible measure in the long term? Of course not! Providing meals on wheels is a preventative measure – it ensures that vulnerable people are visited and includes regular well being and safety checks.
The other issue it prevents is malnutrition. What are the costs to A&E and hospitals for malnutrition? What about the associated problems such as falls, blood pressure, and kidney failure to name but a few? We already know that councils can’t (or won’t) pay the full cost of residential care for those they support, so what happens if people are not self funders?!
I should perhaps mention that some councils are concerned enough to signpost people to their local private provider where the average cost of a two course meal is £6.25 instead of the subsidized council £4.30. However this means that some people will not be able to afford a hot meal every day and that there is no regulation on price increases. Some councils have been particularly imaginative, directing people to local fast food outlets! Is this really the nutritious food that people need on a daily basis?! It’s certainly not very affordable!
So, why have I brought this up as a conflict situation? Simply because NHS England is telling older and vulnerable people to make sure they are having a hot meal every day, whilst the councils are withdrawing the means doing so!
The second example of conflict appears within the different areas of the NHS England. Patients are being told to seek help from 111 or their local pharmacists before even thinking about going to a GP or A&E. This is all well and good, in fact it’s sensible advice.
So, where is the conflict? Well, at the same time as highlighting the services of local pharmacies, they also announce that they are cutting the payments to independent pharmacies – meaning that many will close. So not only does this reduce the number of pharmacies available, it decreases the choice of pharmacies. Another U-turn!
Do you remember our campaign to save our local independent pharmacists? We were all so pleased when it was announced that there had been a U-turn on the issue of local pharmacists and they would continue to be paid for.
Now, why are we so passionate about keeping independent pharmacies when there are dozens of ‘Boots’ on every high street? It is nothing against Boots as such, as they provide many excellent services (although they refuse to have defibrillators in their shops or staff trained in their use but that is another issue!) However Boots’ pharmacists are on a rotation scheme, so they never really get to know the patients and the patients don’t get to know them. Essentially there’s no ongoing relationship and therefore often no trust.
This relationship is important in respect of safeguarding, especially for vulnerable people – they know their patients and they know when there are signs of neglect, malnutrition, or illness and can take action. Furthermore patients are happy to talk to someone they know about their symptoms and – because they know them – will trust and take any advice given. Plus most Boots do not provide a home delivery service. which is particularly important for the housebound and those living in rural areas.
So, there’s the conflict – being told to go to local pharmacists to save GP and A&E services and at the same time cutting the number of local pharmacists available!
I know you will all be able to think of many many examples of conflict between departments and that seamless world of services will remain a ‘fantasy’. Tell us about your best examples of conflict in and between departments.