Integration and the crisis in care – a battle for democracy
Last week it was revealed that Judith Proctor, the Chief Officer of Edinburgh’s Health and Social Care Partnership, was resigning her post. The news came from a leaked email from the City of Edinburgh Council’s Chief Executive. There has still been no official announcement from the Integrated Joint Board (IJB), responsible for managing the Health and Social Care Partnership (HSCP), or from the Council and Lothian Health Board who provide the funding for it. An indication that all is not well.
While the Edinburgh Evening News attributed Ms Proctor’s resignation to a damning report into the state of care services by the Care Inspectorate, probably as important was the proposal to cut a further £35m from services in June. The underlying problem has been the response of HSCP management to years of funding cuts: continued platitudes about the importance of outcomes for people in need of care; denial of the crisis in care provision; and centralisation of management decisions as the answer of how to do more with less.
Those same attitudes informed the Scottish Government’s drafting of the National Care Service Bill which was full of meaningless rights speak, failed to address the resource issues and would have given unelected managers and board members even more power. Judith Proctor was also the Chair of Health and Care Scotland, the body representing and co-ordinating the work of Chief Officers, and gave evidence to the Health and Social Care Committee of the Scottish Parliament about the draft bill last year. Reading that in which she talked about the importance of democratic accountability and listening to people, you would not know there was any crisis in Edinburgh, let alone guess that six months later she would be out of a job.
In practice the management of the HSCP in Edinburgh was doing the opposite of what it preached and acting in an increasingly unaccountable manner. The crisis in its legitimacy originated two years ago in proposals to close five Edinburgh Council care homes without consultation. That sparked a campaign which was very successful in getting local councillors involved in care matters. Those councillors then started voicing concerns about how the HSCP has been taking decisions about council services and their power to influence those decisions through the IJB on which they are represented. The failure of HSCP officers to put the Care Inspectorate Report on the agenda of the IJB meeting of 21st March –they will have had an advanced copy and must have known what was coming – was probably the last straw.
The way the news of Judith Proctor’s departure emerged is therefore highly significant, despite the regrettable cover-up of the circumstances behind it. It appears to represent a blow for democratically elected councillors against unelected officials, including those nominated by Lothian Health Board to sit on the IJB. To their great credit, some of those councillors have been now listening directly to what people with care needs and the workforce is saying and are increasingly aware of the gulf between management speak and reality. Two weeks ago two were present at an inspiring event on social care, held in the Community Well Being space in Wester Hailes, at which I spoke – one for the whole day. Those councillors could now do worse than instigate an inquiry into the failures of the HSCP, including how and why its senior management became so divorced from reality.
On Tuesday this week I spoke at another inspiring event in West Lothian, organised by the Trade Unions. Over 200 people gathered in West Calder to discuss proposals from the West Lothian HSCP to outsource home care provision and close council care homes as part of a three-year budget plan. All voting members of the IJB had been invited but only one, a councillor, attended. Had the others been there they would heard from the audience riveting stories about people’s experience of public services (generally good), compared to private services (generally poor to appalling), support for not-for-profit care provision and considerable anger about what was being proposed. At the end the meeting those present voted unanimously to oppose further cuts and the privatisation of services
Several people asked the councillor who was present what she and her colleagues had done on the IJB to protect public care services. Her answers were very revealing: that she was not on the IJB to represent the interests of people living in West Lothian and what she and other councillors could do was restricted by its governance arrangements. Ostensibly that might be correct. But if so, there is nothing to prevent West Lothian councillors following the example of those in Edinburgh, ripping up the rule book and starting to represent those needing care and the workforce.
What is happening in Edinburgh and West Lothian is only the tip of the iceberg and has much wider repercussions. It illustrates the importance of democratic oversight and control of services at a local level and the inevitable consequences of any further “integration” of health and care services under an increasingly centralised and unaccountable system of management. Humza Yousaf, who has said he is committed to a not-for-profit national care service, should acknowledge the gulf between policy aspirations and reality, and that the current top-down “integrated” system of HSCPs is delivering the opposite. The Scottish Government should consider how care can be returned to democratic control before more Health and Social Care Partnerships start to fall apart and before the National Care Service Bill returns to the Scottish Parliament.