Analysis

MPs demand urgent review of social care funding

It could take ten years to achieve the cultural and system changes needed for health and social care integration, a committee of MPs has found.
FundingTightrope

It could take ten years to achieve the cultural and system changes needed for health and social care integration, a committee of MPs has found.

The timing was uncanny. First came the upbeat tone of NHS Englands progress report on its 2014 Five Year Forward View .

The document, published on the final day of March, claims that over the coming years England will experience the biggest national move to integrated care of any major western country.

Coincidentally, on the same day a no-holds-barred report on adult social care was published by the Communities and Local

...

It could take ten years to achieve the cultural and system changes needed for health and social care integration, a committee of MPs has found.

Money tightrope
Picture: Getty Images

The timing was uncanny. First came the upbeat tone of NHS England’s progress report on its 2014 Five Year Forward View

The document, published on the final day of March, claims that over the coming years England will experience the ‘biggest national move to integrated care of any major western country’.

Coincidentally, on the same day a no-holds-barred report on adult social care was published by the Communities and Local Government (CLG) Committee. 

The report by the cross-party group of MPs is more critical, warning that it could take ten years to achieve the cultural and system changes needed to benefit patients.

11%

cut in spending per adult on social care by councils between 2009/10 and 2015/16

Which report is most accurate? NHS England’s report is full of detail about how change is going to be achieved. It states that the 44 sustainability and transformation plans in development would prompt GPs, hospitals, mental health and social care service staff to work together. It states that the plans will build on the work of the 50 vanguards that have been piloting new ways of working over the past few years.

Samantha Jones, who is stepping down as director of NHS England’s New Care Models Programme, says schemes like the Principia multispecialty community provider vanguard (see panel) show that ‘steady progress’ is being made and that the ‘foundations’ for transformation are in place.

Care rationing

But could vanguards such as Principia be outliers? The CLG committee thinks so. Its report describes how the relationship between health and social care varies greatly between locations.

The main problem, according to the committee, is that funding for care services has been squeezed and councils have been forced to ration care. This has reduced the number of people receiving such care and the quality of services being provided.

The result is that increasing numbers of people rely on unpaid, informal care, while those who self-fund are paying higher fees to subsidise the state market.

This also has an effect on staff. The CLG committee report notes high vacancy and turnover rates, particularly among nurses working in social care.

£2 billion

extra promised to councils over the next three years

More than one in three nurses leave their posts every year, while nearly half of care workers leave within a year of starting. Moreover, those who stay are not always being equipped with the skills to do the job: one in four care workers have received no dementia training or training on how to administer medication.

RCN employment relations adviser Clare Jacobs says these developments have led to a demoralising environment. ‘Despite playing a critical role in delivering care, nurses and care assistants have been repeatedly undervalued, so it’s no wonder they are choosing alternative careers. Low pay, low status and lack of future progression are serious challenges in maintaining the social care workforce.’

Worryingly, these pressures may increase before they get better, the CLG committee warns. Some 7% of the social care workforce is from the EU and could be affected by Brexit.

The committee recommends that the government and Local Government Association develop a care workers charter to set out standards for pay, terms and conditions, training and career development.

Ms Jacobs believes this would be a good idea, saying ‘robust long-term planning’ is essential.

Extra funds

Of course, the government insists action is being taken. In the budget, chancellor Philip Hammond promised an extra £2 billion for social care, to be spread over the next three years. Given that just under £20 billion was spent last year, this extra funding could make a big difference.

As well as the extra funds, the chancellor has promised there will be a green paper on long-term reform.

35.9%

turnover rate for nurses working in social care sector

The problem is, the extra money comes after deep cuts have been made to the sector over recent years – set out in a detailed analysis by the Institute for Fiscal Studies (IFS) (see panel), published shortly after the NHS England and CLG Committee reports. The IFS has found that spending per adult fell by 11% over the past six years.

This is why Martin Green, chief executive of Care England, which represents providers, says that despite the extra money promised the sector is still ‘unsustainable’ and the delivery of the integration agenda ‘untenable’.

‘At present the system is too crisis based as opposed to enabling,’ he adds. ‘This in turn disempowers people to manage their own care.’

Perhaps most telling is not what people say, but what they refrain from saying. When at the launch of his progress report NHS England chief executive Simon Stevens was pressed about whether he is happy with the level of funding available for health and social care, he refused to answer.

 

How one area is integrating care

Principia, one of the multi-specialty community vanguards intended to move specialist care out of hospitals into the community, shows what can be achieved when the NHS and social care sector work together.

The project, run by Nottinghamshire’s Rushcliffe Clinical Commissioning Group (CCG), involves what is known as an enhanced care package.

This has four strands. Residents receive regular visits from a named GP and independent advocacy support from Age UK. Care home managers also meet CCG leads regularly to review the processes.

In terms of nursing, community nurses provide peer-to-peer support to colleagues employed by the care homes, as well as training in areas such as continence, catheter management, wound care and end-of-life care.

Community nurses accompany GPs on their rounds, working closely with care home staff to ensure they have links with specialist teams, such as falls and medicines management pharmacists.

The scheme, which has been running since April 2014, was evaluated recently by a joint Health Foundation and NHS England team.

In its report, the team states that, due to the vanguard scheme, emergency department visits have fallen by 29% and hospital admissions by 23%.

The team also says that there appears to be improved management of health conditions, enabling earlier detection of problems and leading to better decision-making by care home staff.

 

How funding for the care sector has been cut

The Institute for Fiscal Studies (IFS) has carried out a detailed analysis of the areas in England in which funding for adult social care has been cut the most.

The institute found that, between 2009/10 and 2015/16, spending per adult fell by 11% in real terms, from £429 to £381.  Funding fell by more than one quarter in one in 10 councils.

Average spending was reduced most in London (18%) and in metropolitan districts (16%), such as Greater Manchester, Merseyside and Tyneside. Cuts were larger in the north than the south, where unitary authorities reduced spending by 5% during the period.

The IFS acknowledges that spending levels are influenced by the numbers of older people, and levels of deprivation and disability in areas, but adds that these factors explain only a ‘small proportion of the variation’.

 

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