Has the Government made social care less of a priority?

Vicky McDermott is Chair of the Care and Support Alliance which represents 80 of Britain’s leading charities including Age UK, Scope, Alzheimer’s Society and The Royal British Legion and writes:

In quieter times the bleak picture of social care that was laid out in Theresa May’s first week as Prime Minister might have been accompanied by a slew of negative headlines. But with attention understandably elsewhere, that didn’t happen.  Yet while figures were being released that social care needs almost £1 billion to plug the funding gap the responsibility of social care was downgraded from a Minister of State post to the bottom rung on the Ministerial ladder (Under Secretary).

Care and Support Alliance

Mrs May’s welcome ‘One Nation’ rhetoric will have already jarred with the reality that social care now appears to be a lesser priority for her Government than it was for Mr Cameron’s.  Social care ought to be one of the areas that Theresa May looks at seriously because it’s difficult to see how the NHS can become sustainable without it. Even NHS Chief Simon Stevens agrees – he recently told the Telegraph:

“The most immediate need is social care. If home care disappears and care homes close, A&Es are quickly overwhelmed. We need creative solutions.”

NHS figures released on Mrs May’s second day in office, show why he’s saying this.  Delayed discharge has reached record highs. Delayed discharge represents a waste of taxpayers’ money at a time when the NHS is already severely overdrawn. A million hospital days were lost in 2015, costing the NHS £2.4 billion. Social care costs a fraction of the cost of treating patients in hospital and represents better care for patients. Delays because of social care are on the increase, and the biggest reason for social care delays were ‘patients awaiting a care package in their home.’ It is estimated that money wasted by the NHS on excess bed days due to people awaiting homecare could fund 5.2 million hours of homecare.

Next, to add to the woeful picture of the country’s social care provision, was the report on the impact of the spending review on health and social care.  The Conservative chairman of the committee Dr Sarah Wollaston MP put it in stark terms when she said:

“Increasing numbers of people with genuine social care needs are no longer receiving the care they need because of a lack of funding.”

‘Life chances’, ‘social justice’, ‘compassionate conservatism’: it doesn’t matter to those being denied help with the basics such as getting dressed, and help with eating, what you call it.

If schools simply turned children away because they had run out of money there would, understandably, be a national outcry; but the reality is local authorities are being force to deny care to people who desperately need it. People who might need help to eat, and without it will become malnourished. Or people that need help to get dressed so they can get out to a job or a social group.

May said:”Talk to almost any ordinary member of the public and the frustration they feel about the loss of control over their day-to- day lives is obvious.” I would urge the Prime Minister to talk to one of the one million older people who have unmet care needs who have no control over their lives because they are denied the care they need. A properly funded social care system delivers value for money because it maintains people’s dignity and their independence for as long as possible. It supports not just the person that needs care but helps their families too. It also is the best way to keep people from unnecessarily turning to their GPs or hospitals – where they go if they have nowhere else to turn.

Debates around the EU referendum, amongst other things, highlighted that the public has a desire to see their NHS properly funded – and investing in social care would help ease pressure on the NHS.

If the new Prime Minister’s “serious social reform” is to reach the most vulnerable in society – adequate funding for social care needs to be properly addressed.

Transforming care in England

One of the  challenges identified by the Kings Fund for the NHS in England is developing new and better models of care – they write:

The ageing population, changing patterns of disease – with more people living with multiple long-term conditions – and rising public and patient expectations mean that fundamental changes are required to the way in which care is delivered (see Transforming the delivery of health and social care: the case for fundamental change).

What should be done?

Realising this transformation will require a radical shift to involve individuals more fully in their own health and care. This will include making shared decision-making a reality, giving people the support and information they need for effective self-management, involving families and carers, giving people personal budgets where appropriate, and engaging people in keeping healthy. The evidence is clear: most people want to be more involved, and when they are, decisions are better, health and health outcomes improve, and resources are allocated more efficiently.

Health Care

Much greater priority should also be given to public health and prevention. Because of the complex range of influences on population health, this will require collaboration between the NHS, local government, the third sector, employers and others. It will also require action by government, as exemplified by the proposed levy on the soft drinks industry to help tackle childhood obesity. We have outlined opportunities for local authorities to use their powers to improve the health of their populations as part of a broader move towards population health systems.

The implementation of new care models should build on those outlined in the NHS five year forward view. Closer clinical and service integration is needed between hospitals, community services and general practices, health and social care, and physical and mental health. Our work has described examples of specialists working more closely with primary care teams and of general practices collaborating in federations and networks to show how new care models can contribute.

We need a workforce that is fit for purpose, able to adapt to changing demographics and aligned to the new care models outlined in the Forward View. To address this, a national workforce strategy is needed to attract, train, retain and develop the talent it requires to succeed in the long term. This strategy should include consideration of remuneration, training, culture and career development.

We also need to embrace innovations in digital and other technologies, for example, implementing an electronic care record to facilitate access to information about patients wherever they seek care.

“The challenges are immense and the outcomes could be for better or worse”