If evidence was needed to improve the social care offer to those who need it, then we should look to the statistics published by Age UK, which highlight that one in six emergency admissions to hospital, over the age of 75, are people who have been discharged only 30 days earlier.
This very simple, but powerful, statistic signals that we are not putting people first but are working with processes and targets. Despite all the promises and rhetoric, no incumbent of 10 Downing Street has fulfilled the bold vision of ‘fixing social care’. In order to do that they must first understand and appreciate the role and value of the sector.
At its very best, social care delivers services to those who need it, when they need it based on their personal assessments, and a personalised service which enables the individual to have the best outcomes. The best is what we must work towards.
When we focus on health alone, what we do is devalue the contribution of social care but, more importantly, we overlook the fact that, without the community offer, the NHS will always struggle and failure is almost inevitable as it becomes overwhelmed. We can increase capacity in the NHS but, if we don’t invest in the community, there is no-one to pick up the baton for the individual being discharged into the social care offer.
Until we acknowledge the health needs of the individual being supported under a social care banner, and provide the resource, we will be cutting corners and risking failure.
Through national and local engagements, we have areas delivering some collaborative support within communities such as virtual wards, which enable safe discharges into the home setting; recovery can be monitored and support increased or decreased as required in the best interest of the person at the heart of the service. The reality is that once acute interventions are complete, a hospital setting is not the best place for people who can be supported in the community.
We know that much more can be done and it would be in the best interest of the person receiving care. We need to look at the preventative agenda and, to do this, we must ensure there is sufficient support in communities to prevent a crisis leading to the doors of A&E. Without a plan to address the issues of recruitment and, most importantly, retention, we will struggle to deliver high-quality services in the community.
We are often being signposted to pharmacists as GP numbers are also shrinking, but there are also shortages reported in the pharmaceutical profession. Currently, we know that 45% of older people are concerned about their access to GPs, which then leads to the A&E route. That alone creates an enormous problem in communities.
The workforce crisis in social care has led to a sharp increase in informal carers who themselves can be older people with health conditions. When packages of care cannot be found, and the bed needs to be vacated, decisions are being taken based on family support. The subsidy of informal care hours being provided is a gap which needs to be filled. We cannot expect untrained individuals to deliver care and support to loved ones without providing emotional and financial support for respite to ensure that relationships are protected.
What we need is a concentrated effort to encourage real investment into the sector, with timelines to nurture innovation and solution-based outcomes. It should be remembered that all GP surgeries are private businesses and hospitals buy private care to support operations etc. Therefore, a private, sustainable and robust social care sector can be the route to creating the pathways our citizens deserve. Decision makers need to be clear that allowing that sector to collapse will destabilise the NHS and that would be a huge catastrophe for our citizens.