NHS Reset: Care homes must be allowed to evolve and become fit for the 21st century | Prof Martin Green

Martin Green

NHS Reset is a new NHS Confederation campaign to contribute to the public debate on what the health and care system should look like in the aftermath of the COVID-19 pandemic.

In this blog, part of a series of comment pieces from NHS Confederation members and partners, Professor Martin Green looks to a future where care homes are recognised as an essential element of the continuum of care.

While some parts of the system managed to respond to the COVID-19 pandemic and adapt very nimbly, they were juxtaposed by the plethora of bureaucracy which makes one wonder whether the system works for us or we for the system. 

The focus was undeniably on the NHS and this was at the expense of the many thousands of people both living and working in care homes. Discharging patients from hospital into care homes without COVID-19 tests compacted with insufficient personal protective equipment for care homes spelt disaster. We know this now and when a second wave hits, we should be better prepared. Care homes don’t so much need a ring of steel around them, but rather they need to be recognised as part of the fabric of health, social care and, of course, society. The Department of Health and Social Care needs to be just that, rather than social care as an afterthought. It also needs to take a long hard look at the quangos and agencies.

COVID-19 was a watershed moment. We have learned a lot and want to help construct the new normal for health and social care. Part of this is reclaiming and redefining the term integration, going right back to basics and seeing this in terms of the individual citizen. In a crisis, we require the part of the health and social care jigsaw to slot together quickly. We are now in a position to wonder why in ‘normal’ times it takes so long to discharge to assess, or why IT systems couldn’t talk to one another now that NHS Mail has for the most part been rolled out in haste to all care homes. This impetus needs to be harnessed and not forgotten. 

Bureaucracy has characterised the pandemic. What is required now is a different culture, one where success is measured in outcomes. We have learned that a narrow focus on one element, in this case the NHS, has undermined the focus on those most vulnerable. Over the years, we have seen endless structural reorganisations and now is the time for delivery; part of this can be via a cultural reorganisation. Some quangos and agencies were simply not nimble enough to deliver, thus begging the question whether they are fit for purpose.

COVID-19 has shown that care homes are an essential element of the continuum of care. We at Care England are really enthused by the evolving concept of the care home of the future, those fit for the 21st century. Providers need to have the flexibility to play to their strengths and innovate, for example growing their rehab and reablement, providing extra day care or night support services and becoming hubs for the management of long-term conditions. All this is necessary for the prevention agenda and embracing the new normal in a post COVID-19 world.

Professor Martin Green OBE is chief executive of Care England. Follow them on Twitter @ProfMartinGreen and @CareEngland

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