Hospitals are in the headlines again. NHS Providers, the body that represents NHS acute, ambulance, community and mental health services has warned that the NHS faces a deepening financial crisis. Indeed, our most recent Quarterly Monitoring Report found that NHS finances remain very fragile and that it would be premature to suggest that the financial pressures that have engulfed the NHS have eased.
The problems don’t stop there. For each month so far in 2016/17 there has been the equivalent of an additional 54,000 attendances at A&E and 14,200 admissions from A&E compared to the previous year. Key targets are being missed and the scale of these performance issues cannot be shrugged off as poor management. This is a systemic problem.
Many of these additional emergency admissions are older people. They are also more likely to be stuck in hospital when they are ready to go home – a ‘delayed discharge’ in policy parlance. Why? Many people point the finger at social care ‘supply’. Of course, the truth isn’t quite as simple as that. The system of assessing needs and putting care packages in place can be complex, slow and cumbersome. What is clear is the growth in unnecessary waits for health or care packages in individual’s own home have increased over and beyond delays for any other reason.
Our new report with the Nuffield Trust, Social care for older people: home truths, follows on from our recent work on primary care and district nursing in highlighting the growing divide between the policy rhetoric of ‘care closer to home’ and the reality of a fragmented system. Our assessment of national data and in-depth interviews in four unnamed local authority areas found that the past six years have brought huge pressures on the social care market. Reductions in central government grants to local authorities have been passed on to care providers in the form of reduced fees, or below inflation increases, squeezing their incomes so much that some are now stepping back from providing care to people funded by councils.
The pressure is greatest on home care providers but the highest price – human as well as financial – is being paid by older people, their families and unpaid carers. Access to social care increasingly depends on what people can afford — and where they live — rather than on what they need. This favours the relatively well off and well informed at the expense of the poorest people who are reliant on an increasingly threadbare local authority safety net.
The combination of under-investment in primary care and district nursing, as well as social care, means older people are more likely to end up in hospital and get stuck there if the right community support is not available.
Politicians and policy-makers have two choices. They must either be honest about what the current system can deliver in a context of ever-increasing demand and shrinking resources (revising both the legislative and policy basis of the health and care systems). Or they should face up to the fact that, as a matter of national importance, we must undertake long-term reform to funding for health and care. This means acknowledging the reality of the costs of good care and where the money comes from to pay for it, accompanied by real investment to scale up emerging better, more community-focused models of care. Otherwise, our aspirations of keeping people well in their own communities will remain just that. It is time for some home truths.
Patrick Hall is a Fellow, Social Care Policy at The Kings Fund.
LGiU will be publishing a briefing on this report very shortly.