That, more often than not, the more local the leadership, the better. This ranged from carer\u2019s initiating changes in service to adults of working age in particular holding personal budgets that gave them the ability, singly and jointly, to arrange the services they need. Councils that actively sought and supported feedback – from service users and from providers \u2013 were themselves valued. The best organisations seemed to cherish such engagement, the poorer ones tending to hide from it. As with the NHS, we heard of much variation around the quality of care and services, and, again as with the NHS, much depended on personal relationships and the ability to understand the other side\u2019s problems and seek to address them.<\/p>\n
Where there was almost universally withering criticism was of the Department for Health and Social Care, where, until very recently, the role of a Director General for Social Care has gone missing. Interviewees complained of a \u201cvacuum\u201d of leadership nationally and \u201ca really quite astounding lack of understanding of social care at the centre.\u201d\u00a0 The department does now seem to be addressing that, but our interviewees were clear that there is a way to go.<\/p>\n
Given our small sample size, we were reluctant to make recommendations but we have put forward ideas for debate. There is a desperate shortage of training and career development in social care at all levels, certainly compared to the NHS, with expenditure averaging about \u00a314 per head. What, one might ask, can you buy for that? Despite repeated government promises to improve matters, there is a lack of good data on social care \u2013 on workforce, market stability, the outcomes of care and cost-effectiveness, with the lack of data inhibiting research. There are options available to take some of the heat out of the annual battle between councils and providers over fees, and a case for the myriad trade bodies and other organisations that represent social care coming together to provide less cacophony and more of a single voice for social care. There is also a case \u2013 as the government now appears to be proposing as part of its NHS legislation<\/a> \u2013 not just for improved data but for an assessment of how well local authorities, and indeed the NHS, are delivering social care. Not, in our view, \u00a0so much as a means of policing them as one for strengthening the hand of those responsible for social care amid squeezed local government budgets, and as a means of highlighting and spreading best practice. \u00a0All this, we argue, might make leadership in social care easier.<\/p>\n Good leadership matters. But it can only get one so far in an underfunded system where the \u201cfix\u201d to social care has been long promised but seems to be forever just around the corner. But the good news from these interviews was that most of those we spoke to believed the integration of health and social care is making progress. And while our focus was on long standing issues in social care, there were reports that the need to act swiftly during the pandemic had both broken down barriers and led to a better understanding in at least parts of the NHS of the importance of social care. The worry was whether, as the pandemic eases, that will last.<\/p>\n Richard Humphries\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Nicholas Timmins<\/strong><\/p>\n Richard Humphries and Nicholas Timmins are senior fellows The King\u2019s Fund.<\/p>\n Declaration of interests<\/strong><\/p>\n We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.<\/p>\n","protected":false},"excerpt":{"rendered":" COVID-19 has thrown social care in England into the spotlight in a way that nobody would have wanted. The death toll in care homes, in people\u2019s own homes, and among care staff. The desperate early struggle to get personal protective equipment to carers that mirrored the problems in the NHS, but at times seemed worse. […]<\/p>\n![\"\"](\"http:\/\/blogs.bmj.com\/bmjleader\/files\/2021\/03\/HUMPHRIES_RICHARD_YAMMER-PHOTO_0-300x300.jpg\")
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