Wednesday 27 November 2013

Parthian Shot

It was uplifting to see the parting shot of the Welsh public services Ombudsman Peter Tyndall who, after years of fighting the corner of people trying to make sense of getting help simultaneously from both health and social services, said the apparently unsayable and suggested the two should be joined up - not just talk to each other, not just "share budgets", but merge into a single structure which would then be unambiguously responsible for vulnerable people.

I have met Peter several times and he was always attentive to Hafal's advice about assisting people with a serious mental illness. He's a wise man with his own mind and we should listen to him.

This is what he said...

"We need to be much better at delivering integrated packages of care than we are at the moment and that will need structural change. Many more people are living in the community and receiving support... Often that support is coming from private or voluntary bodies; on the other hand, you have nursing care from the district nurses, occupational therapists and physiotherapists and so on. We need to look at that as a single joined-up entity instead of the fragmentation we currently have.

"It's all very well to say to people to share budgets and so on, but why do you have separate budgets in the first place? Why do you have separate agencies in the first place? I think that's a historical accident and it needs to be corrected."

Amen to that, though not really an historical accident, I would say. The origins of social care as a separate undertaking were not accidental but a worthy effort by the post war state to see caring for people as a wider mission than treating health problems - and of course much good has been done as a consequence. I am not in the business of attacking social workers.

But here is a difficult truth. Citizens never asked for a separate social care agency and to this day they don't understand the point of having separate health and social care structures.

The argument for separate agencies has been made strongly over the years - not by consumers but rather by well-meaning busybodies, not least mental health organisations who to this day wring their hands about the distinction between "social" and "medical" models of mental health care. In practice patients do not understand this argument and find it bewildering, not because they are stupid but because these false distinctions have no relevance to the real lives of people seeking help to recover from their illness.

In fact a mistake was made from the outset (with the benefit of hindsight) and it would have been much more practical - and make much more sense to the public - to have broadened the concept of health (and so also the mission of health services) to embrace social care needs, child and adult protection, etc. This would also remove much of the stigma and public suspicion about social work.

And there is now an opportunity to put this right as I have previously pointed out here.

Mr Tyndall has gone to Ireland to be their Ombudsman - good luck to him and them - and we are left with his advice ringing in our ears. The Welsh Government has reiterated its policy of encouraging cooperation but not supporting structural change. But we've tried that for years and it doesn't work.


"Parting shot"? Pub bores with a classical education will tell you that the origin of this expression is the practice of ancient Parthian (Parthian = parting, geddit?) cavalrymen pausing as they ride away from an enemy to fire arrows back.

Complete nonsense, of course, invented by some wind-up merchant in Victorian times. "Parting" just means "departing" as any fule kno.