Health Secretary Matt Hancock has just announced an extra bit of cash to reduce what’s pejoratively termed ‘bedblocking’ – the delayed release of people from hospital because appropriate care at home or in residential care facilities cannot be found. In particular, this money seems to be primarily directed at home care to help ease ‘winter pressures’ on the NHS.
While cash-strapped councils are likely to welcome any help on offer, it’s estimated that around a billion pounds is required just to shore up the crumbling independent care market.
It’s not hyperbole to say that the social care system is on the brink of collapse. It’s not just bedblocking that’s the problem. There are some other worrying signs on the horizon:
Rising demand – there are already over a million people in the UK with unmet care needs against the backdrop of rising numbers of older people as a percentage of the population.
Care providers going bust – care companies are going out of business at an increasing rate. This can mean costly intervention as well as personal misery in terms of people’s care being disrupted or individuals being overlooked and serious health consequences when frail and elderly people are moved from residential care.
How far will £240m go to alleviate the pressures? Not very, to be honest. You cannot fix care by throwing small-ish pots of money at a system that is no longer fit for purpose.
A new approach to care needs to focus on:
- Service innovation and practice improvement – There needs to be better support for innovation as well as proper evaluation of outcomes and the ability to disseminate and implement better practice.
- Funding for the future – More worrying than the funding gap for those who qualify for state support is the self-funding gap. Currently there are no financial products to help people plan for and pay for care. There is interest from the financial services industry, but there is insufficient policy stability for them to enter the market.
- Incentivising integration – Social care and the NHS need to work more closely together. But there is no consensus on what integration should look like.
- Regulatory regime – Currently there is little to no regulation of the services provided by social care departments in the UK. While the LGiU would never advocate a heavy regulatory regime for local government, there is perhaps some greater need for supporting more self-regulation and the transfer of knowledge of best practice.
- Improved staff conditions – Care workers are overworked, underpaid and still being paid less than the legal minimum wage in some cases. They are undertrained and allowed little discretion even when they are skilled and well-trained. They are the ones caring for people and often know far better than a potentially out-of-date care plan what needs to be done. We need to be able to harness the skill and aptitude of good care workers, so that we need fewer mediocre ones.
- Support for carers – Without the ability to plan for or insure against the need for care, many people are finding themselves in the position where there is no money to provide care for a partner or relative, but no state aid either. Many feel forced to leave the labour market, often against their will and certainly against their interests. Any comprehensive care reform must include economic support for carers, either through a carers’ working tax credit or other means.
If there is to be any real reform in adult social care, these are the six key areas which must be addressed. We believe that if adult social care is treated and funded as a worthy goal in its own right, then ‘bedblocking’ will reduce naturally.
More funding, even adequate funding for a system designed to focus on the wrong things such as time and task care rather than outcomes won’t help people live better lives. Adult social care needs real and sustainable sources of funding and it needs a radical overhaul. The much promised and oft-delayed Green Paper is an opportunity to focus on improved quality of life, dignity and independence. Treating symptoms and not causes is neither good care nor good policy.
Jonathan Carr-West is the Chief Executive of LGIU. This article first appeared in The Municipal Journal.