Is it just me…?

Editor in Chief, Robert Chamberlain considers the current nonsensical approach to improve health and social care for our ageing population.

Newspaper readers are frequently met with headlines such as ‘Can the NHS be saved?’ or even ‘Who can save the NHS?’ Valid questions indeed, but just how much worse would the NHS’s predicament be right now if informal carers ceased their roles and the underfunded social care sector collapsed?

There are an estimated 6.5m unpaid carers, saving the Government approximately £119bn according to the latest research from Carers Week. One would, therefore, think that everything possible was being done to support these caring individuals to continue their invaluable roles, especially in austere times. But no, this is not the case. The research shows that two thirds of carers consider one or more local services are not carer friendly and that 60% felt that a lack of services was having a negative impact on their health. Bear in mind that a reported 87,000 carers are themselves aged over 85 with this number expected to reach 200,000 by 2030 (Carers UK and Age UK, 30th April 2015). This ‘invisible sector’ is creaking like the others in health and social care.

In crisis

The social care sector is undoubtedly in crisis. The under-funding of care homes is well-documented, especially for generalist residential care providers. Recipients of homecare are receiving shorter and less frequent visits of varying quality.

According to research by The Good Care Guide, 39% of reviews from those receiving homecare report bad or poor standards. Sizeable operators including Saga (Allied Healthcare) and Care UK are withdrawing from the domiciliary care market due to the lack of financial viability of local authority contracts. This is a particular worry for commissioners, many of whom have made ends meet in recent times by reducing the number of contracted homecare providers in favour of a smaller number of larger outfits. What will be the impact on already stretched local authority budgets if the big players stop tendering for their business?

Will there be a sufficient number of smaller operators in existence to fill the void, after having been starved of council funding for a prolonged period?

The Association of Directors of Adult Social Services’ (ADASS) Annual Budget Survey reports that 56% of its directors have ‘genuine concerns’ relating to the financial predicament of care providers with implications for quality of care. Yet there are further reductions to the social care budget (£13.3bn 2015/16 compared to £14.9bn in 2010/11) and greater demand for services. Of the promised additional money from the Better Care Fund (BCF), ADASS President Ray James commented, ‘It is palpably absurd to believe that the money being transferred from the NHS via the BCF is anywhere near sufficient to mitigate these spending disparities.’

Who can save the NHS?

Back to the headline ‘Who can save the NHS?’ A well-supported army of informal carers and a properly-funded social care, that’s who. A broken support system will most definitely lead to greater pressure on health services and to ignore this link is beyond naive. Furthermore, a well-functioning carers network and social care intervention would save even greater sums from NHS budgets. Isn’t this blindingly obvious?

The planned funding reforms for social care from 2016 will fall far from the required mark in terms of financial support and will, in fact, place even greater pressure on local authority budgets and resources. Yet I fear that the ‘carrot dangling’ of the reforms is the Government’s justification for leaving social care’s plight unaddressed.

The Government has the opportunity to take necessary and urgent action to inject greater funding into the very services that keep people out of hospitals in the upcoming Spending Review. A failure to do so will put the wellbeing of the most vulnerable in our society at risk, undoubtedly resulting in increased demand on NHS services.

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