The continued delay in the Government’s Social Care Green Paper is just one more indication of the lack of consensus and considered thinking being applied to the social care crisis in the UK. The lack of care in the community is turning our hospitals into extended care homes – which is wrong on every single level. It is the most expensive place to care for the elderly. It hastens their decline. And goes against every piece of healthy aging research: independent living with the right level of support is what people want. It is best for their long term health. And, it is the least costly way of delivering care.
Yet there is not a single government policy that supports this approach. With even more money being allocated to the NHS rather than social care provision, a diagnostic lottery when it comes to access to state funding and a disturbing gulf in the quality of local authority funded and self-funded care services, Helen Dempster, Chief Visionary Officer, Karantis360, discusses the changes urgently required.
After a decade of austerity led government, every penny counts. Yet when there is a crisis in social care, why is an additional £20.5 billion being allocated to the NHS over the next few years and nothing to adult social care? Indeed, despite rapidly rising demand, annual funding is down £700 million in real terms compared to 2010/11, according to the Economic Affairs Committee.The Health Foundation and King’s Fund estimate that to return quality and access to levels observed in 2009/10, the government would need to spend £8 billion.
Of course bed blocking is a massive issue – but throwing resources at managing the problem within the NHS rather than addressing and preventing it within the community is a flawed strategy. Financially, the economics are staggering. An acute hospital bed costs £1,200 a night. Elderly patients stuck in hospital due to a lack of social care in the community can be there for weeks. This adds cost at every level – from causing delays in A&E to undermining nursing morale, leading to staff turnover and hiking up recruitment costs. Analysis by the Alzheimer’s Society shows that, since March 2017, people with dementia have spent more than one million unnecessary days stuck in hospital beds, despite being well enough to go home, at a cost to the NHS of over £340m.
To put this funding into context – £20.5 billion is more than the entirety of local authority adult social care expenditure. Just consider how many more individuals could be cared for at home if just a fraction of that money was allocated to adult social care. For the price of just one acute bed for one night, a care agency could have 120 hours of care at a decent rate of pay – that is 30 carers, each working an eight hour shift!
Furthermore, the allocation of funding towards the NHS to support elderly care goes against every piece of thinking when it comes to healthy ageing. Individuals want, as far as possible, to stay in their own homes. Every intervention, every stay in hospital or care home, hastens an individual’s decline and undermines their quality of life. So when keeping people at home as long as possible is not only less expensive but it is what they want – why is the funding, the strategy, the entire social care model not predicated on achieving this goal?
There are a number of fundamental changes required. Firstly, we need to recreate respect for the caring profession – and that means increasing standards. Right now many families have valid concerns regarding the standard of care available, but this will not change unless the attitudes to carers, their value and skills change.
Caring can be hugely challenging – and heart breaking. Carers often work alone; they have to squeeze multiple tasks into one visit – 15 minutes to get a vulnerable individual out of bed, washed and fed is simply impossible – especially when that process also requires time consuming paper work. Where is the essential interaction between VIP and carer? Where is the enjoyment in the job? Carers never know what is coming next. Information is rarely shared, so carers don’t know if the next VIP is one who suffers from mood swings or has been going downhill recently. Under the current model, carers simply do not have the time to care. And frankly, given the level of stress and bad pay, is it any wonder that some individuals in the industry don’t have a desire to care?
Pay and Standards
Change is essential; but right now the interventions are little more than dabbling. Matt Hancock, Health Secretary, has pledged up to £3 million this year for care managers to access learning and development to improve skills. He also highlighted the government’s £3m recruitment campaign to attract the right people into social care and announced a rise in the Carers Innovations Fund from £0.5m to £5m to support informal carers. But the rate of pay is still a disgrace. Why would an individual take on this stressful role when it is possible to earn more money stacking shelves in a supermarket?
The industry needs to attract and retain the right people, those individuals who truly want to care as a career. For a start, why not make the budget available to increase the hourly rate to attract the right people? Building on this with a set of caring qualifications to offer individuals a clear career path and enable consistency in training, will aid recruitment. With the right pay, conditions and qualifications the industry can attract and retain the right people to undertake this key job.
It is also essential to look at the lottery that is social care funding today. From the different policies and funding models employed by Local Authorities to the diagnosis based allocation of resources, families and care providers spend far too much time battling over care. This care gamble needs to end; and that means creating a consistent strategy for access to care services – a central, rather than local authority, delivery model. Removing the diagnostic qualification for care would also address not only family strain but also a huge administration layer where Local Authorities, family and care providers battle for access to services. A simple model where there is no self-funding unless an individual opts for private healthcare, is in line with the current NHS approach and would drastically simplify the process of funding allocation.
Allocating funding to the NHS to support elderly care is ill-judged. When the root cause of many NHS problems, from A&E delays onwards, is due to bed blocking, it makes far more sense to improve the quality and availability of adult social care available in the community to get these people home, safely.
In addition to raising the pay of carers to drive up quality, intelligent use of technology can reduce costs associated with care. This enables care providers to provide better care in the VIP’s own home, supports early interventions that avoid the health issues that can lead to a VIP going to hospital or care home that are proven to have a negative impact on health and well-being, as well as adding to the cost of care. With the right care package for each individual, a VIP’s wellbeing improves, and the cost benefits are tangible.
It is simple economics: allocate the funding to the area that will deliver the most benefit. And in this case, it is adult social care, not the NHS.