Last week the chairs of three Parliamentary Select Committees, including Sheffield MP Clive Betts, wrote to the Prime Minister encouraging her to set up a cross-party review on sustainable funding for social care and health as soon as possible. Why is this so urgent, and why must health and social care be considered together?
Social care refers to personal care and support, other than healthcare, needed by people of all ages with disabilities or chronic illness. For an older, frail person, social care is likely to be a home help assisting with washing, dressing and preparing food.
It seems the wrong time to be taking money from a publicly provided health service and putting it into poor quality private provision
It includes care given in a residential setting, for instance in an old people’s home, provided alongside the food and lodging itself and anything defined as nursing care.
From the point of view of the recipient and their family, the distinction between social and health care is irrelevant: you cannot be healthy unless your basic needs for food, shelter, personal care and some kind of human contact are met.
Looking at things holistically is especially important towards the end of life.
Medical care is generally understood to be about returning people to health and independence and preventing disability and death.
The hospice movement has encouraged the health professions – and the general public – to also recognise the value of making dying more comfortable and dignified, but so far the debate has been restricted to what happens in the last few weeks or months of life.
A ‘good death’ can be planned and resources mobilised for someone with terminal cancer and only a few weeks or months to live, but what about people, especially the elderly, who are never going to ‘get better’ yet still have many months or years to live in need of social, nursing and medical care?
They and their families will find themselves scrambling to obtain a ‘package’ of care, starting with an assessment of whether the needs are ‘social’ or ‘nursing’ and whether they are ‘critical’ or ‘moderate’.
Free social care is heavily rationed and means-tested. In most cases it will be limited to brief visits by an overworked and underpaid home help two or three times a day. Any gaps in care must be paid for or filled by friends, family and neighbours. Only people with a well-defined illness (not including dementia) are entitled to nursing care. This, being an NHS service, is free though it is still subject to assessment and cost-control. Social care is provided by local authorities, which are currently funded from central government, topped up with business rates and council tax. Social care is a statutory duty but comes out of the same funding pool as core services like waste collection and road repairs.
Over many years, central government has heaped responsibilities on local government (in the name of ‘localism’) without substantially increasing its funding.
The Coalition/Conservative governments of 2010 and 2015 have made swingeing cuts to local authorities especially in the north of England.
The situation has been compounded by contracting out services. In Sheffield, the council now has long-term contracts with fixed financial commitments to private companies such as Veolia and Amey. Social care has also been outsourced in a vain effort to make it more efficient and affordable but using short-term, low-cost contracts which are easier to cut. Demand is rising and so are costs. Sheffield Council is this month on course for a £6.2m overspend.
As a result fewer people are getting social care.
This has a knock-on effect on the NHS, because frail people without adequate social care end up in A&E. Once there, they languish on a trolley or hospital bed waiting for a ‘package’ of care to support them back home. The cost of a hospital stay is far greater than home care so ultimately money is wasted across the system. Also, the burden on the family affects their health too, sometimes severely.
One solution would be to shift money from health to social care. The regional Sustainability and Transformation Plan talks about unifying health and social care and saving money by caring for people ‘closer to home’, but is rightly distrusted because it reckons on doing so within the context of a £571 million (14 per cent) funding gap by 2021.
With the NHS in crisis, it seems the wrong time to be taking money from a publicly provided health service and putting it into what is currently poor quality private provision. Equally, giving councils ‘permission’ to raise additional council tax for social care is neither adequate nor fair.
The Barker report, published in 2014, recommended that the money should come from central taxation, raising the total amount spent on care to just under 12 per cent of GDP, which is still less than comparable European countries spend on health care alone. This seems the best solution to me. It is not just a question of relieving pressure on the NHS – it is about affording elderly and disabled people a decent quality of life.
The council’s Sheffield Home Care Needs Assessment published in January 2016 found that:
l Numbers receiving home care were dropping year on year (by 8.8 per cent in 2013/14)
l Every week, over 100 care users were waiting for their package to start
l Ninety-six per cent of care workers were on zero hours contracts
l A quarter of family carers provided more than 50 hours of care a week