Social care crisis

Source: ASCC

 Funding social care was the subject of Key Issues for the New Parliament 2010. It read:

In 1997 Tony Blair told the Labour Party conference “I don’t want [our children] brought up in a country where the only way pensioners can get long-term care is by selling their home.” Local authorities have been able to require people to sell their homes to pay for residential care since 1948. Thirteen years after Tony Blair’s speech, local authorities continue to do so. 

The system was seen as inherently unfair, penalising those who have saved for their old age, whilst those who have been less prudent are eligible for state-funded care.

The Money Advice Service web page includes a  table: Local authority funding for care costs – do you qualify?

Source: money Advice Service

 Age UK has a useful explanation of the means test when paying for care. The NHS also has a guide to care and support. Health and social services in Wales are explained here and here.

No comfort there for the frugal. Anyone who has saved for their old-age hoping to pass on their property to their children, especially now that it is so difficult to get onto the property ladder, is likely to regret the fact when the profligate are rewarded.

The Commission on the Future of Health and Social Care in England (also known as the Barker Commission) was asked whether the post-war settlement, which established separate systems for health and social care, remains fit for purpose. Three problems were identified:

Problem 1: the system is unfair  Most health care (major and minor) is free at the point of use. Social care is heavily rationed and means tested. This leads to situations where people with dementia have to pay for their own care while people with cancer don’t. Both cases involve significant care needs but they get very different levels of assistance from the state. There is not equal treatment of equal needs.

Problem 2: the funding is separate  The NHS budget is ring-fenced, comes mostly from national taxation and must be spent on health. Publicly funded social care is paid for by local authorities through a mixture of central government grant, council tax and user charges. Levels of spending vary across the country. Deciding who pays for what is a constant source of friction which can impact on people who are caught between the two systems.

Problem 3: the system is not co-ordinated  The organisations that commission health and social care - 211 clinical commissioning groups for hospital care, emergency care, community care and mental health; 152 local authorities for social care; and NHS England for primary and specialist care - are not aligned. This creates inefficiencies with financial and human costs. For example, 3,000 beds a day are occupied by people who are fit to leave but are stuck in hospital while funding or assessment is resolved.

The current system is unfair, unjust and unsustainable. Bed-blocking up by 52 per cent in three years, NHS figures show. For example, Patients in England experienced some 177,000 days-worth of delays paffecting more than 5,900 beds a day in April 2027. "The problem was projected to cost the NHS £169m directly for the 2016-17 financial year, but the National Audit Office believes the overall related cost may reach some £820m annually, according to David Hare, the chief executive of NHS Partners Network."

Last January, YouGov research showed 53 per cent of people supported the idea of a 1p-in-the-pound rise in National Insurance, from 12 to 13 per cent, if it was used to fund healthcare, while 26 per cent opposed it—down from 37 per cent in 2014.

The Illustrated summary of the Barker Commission's final report posed the question 'How can we afford it?' giving examples of how almost £6 billion could be saved and suggesting a review of taxes on wealth and consider reforms to inheritance tax, wealth transfer tax, capital gains, property tax, etc.

They conclude, "Overall, the government should assume that public spending on health and social care will increase from 9.6% to 11–12% by 2025. The commission believes that in the long run this is affordable and sustainable" pointing out that it "sounds like a lot of extra money but it’s still less than other similar countries spend on health care alone."

Source: King's Fund

A report in the Telegraph shows that "the growing NHS crisis has been fuelled by the closure of almost 1,000 care homes housing more than 30,000 pensioners."

It comes as NHS figures show the worst Accident & Emergency crisis on record, amid a 37 per cent rise in the numbers stuck in hospital for want of social care, since 2010. Experts said hospitals were being overwhelmed by the spread of flu because they had almost no spare capacity to cope with surges in demand.

The report by industry analysts shows that in the last decade, 929 care homes housing 31,201 pensioners have closed, at a time when the population is ageing rapidly. The research from LaingBuisson show care homes going out of business at an ever increasing rate, with 224 care homes closed between March 2016 and March 2017, amounting to more than 2,000 beds."

For far too long Local Authorities have regarded care providers as charities resulting in business closures or demeaning 15 Min home care visits.

It is over twenty years since Tony Blair told the Labour Party conference in 1997 “I don’t want [our children] brought up in a country where the only way pensioners can get long-term care is by selling their home".

We can't wait another twenty years. Action to integrate health and social care is needed urgently, free at the point of delivery, raising revenue as necessary to assure equity. It could even be a vote winner.

Postscript [16.01.2018]

Revolution in health and social care urged in Wales

Nine leading international experts, chaired by the former chief medical officer for Wales Dr Ruth Hussey, have been looking at ways to try to put the health and social care system on a stronger footing. Ministers say a new plan will take into account the review's recommendations.

Without "significantly accelerated" change, services which are already not fit for the future, will further decline, the expert panel warns.

The NHS and social care will be expected to work "seamlessly" together to respond to a person's needs and to deliver care closer to home.

Who cares?

From the BBC video 'Do you remember that, mum?'

A recent BBC report 'Do you remember that, mum?' explained how the condition of dementia sufferer Andriani, who was last seen in 2014, had deteriorated rapidly while the costs to care for her rise.

The report explains why the son fears for his mother's future care. He explained that he would like to be able to say that the system is broken so potentially it could be fixed but having seen it from the inside he said "I don't think we have a system at all". Sadly that is the experience of most people who have had the misfortune to be involved. They are desperate to see a fully funded, workable system.

Care should not be a lottery but it is. If you have cancer much if not all of your treatment will be paid for. If you have dementia, hard luck. You are often on your own. The effects can be devastating but who cares?

On the face of it, raising the assets limit to £100,000 from £23,250 in England may appear "reasonable" but it is not. Read why here and here. The fate of someone who has lovingly cared for his/her parent at home when the parent dies and the family home has to be sold to settle the care account is an added burden. "As soon as my mum dies, will the council come for its money? Will I be homeless?" asked one carer.

The Institute for Fiscal Studies warned that the "complex new system" outlined in the Conservative party’s manifesto, which would force more elderly people to pay for their own care, “makes no attempt to deal with the fundamental challenge of social care funding”. This warning is backed up by the economist Sir Andrew Dilnot who reviewed social care for the coalition government in 2011.

Accusations that the Tories were imposing a 'dementia' tax and a 'death' tax prompted a swift clarification that there would be a limit on the costs carers would be expected to pay but that would have to wait for a green paper consultation. The Prime Minister said “I want to make a further point clear. This manifesto says that we will come forward with a consultation paper, a government green paper. And that consultation will include an absolute limit on the amount people have to pay for their care costs.”

Under the 2010 to 2015 Conservative and Liberal Democrat coalition government we were told that "people will see health and social care fully joined-up by 2018...Co-ordination would see better care and support, fewer people falling through the cracks and a drop in patients needlessly stuck in hospitals." Some hope!

Getting bed-blocking patients out of hospitals into domiciliary care was seen as a priority but with the UK home care industry on the brink of collapse there is a grave danger that any action will be too little too late. As one care provider said in a BBC interview, he doesn't have to advertise for customers but he has to advertise for staff. There is a recruitment crisis due to competition from hospitals and supermarkets.

Carers are severely undervalued. They should be properly rewarded but funding has been squeezed to such an extent that many existing carers are leaving for less demanding work. This is an extra burden for providers who have to train their staff at considerable expense only to find that they leave for a hospital job on regular hours. The Labour party has made much of zero-hours contracts, now the subject of Government review, but it is the flexibility of not having fixed hours that enables carers to meet the needs of those they care for.

The situation gets worse by the day. It could be you next, it could be me but who cares? That is the question. The right answer is needed urgently before the system collapses completely.

Postscript [27.05.2017]

Number of pensioners needing care set to rise by one quarter: Lancet

Conman rides again

Conman and his faithful companion Dobin

The cost of the NHS in England for 2012/13 it is around £108.9 billion. An additional £500m bailout over two years has been announced to help struggling A&E departments through the winter months providing a sticking plaster for the period up to the general election. To put these numbers into proportion: "Out of every £100 of national wealth (GDP) we spend £8.70, compared to the US £16 and are well below the Western average. Greece and Portugal spend proportionately more on health than the UK. The public need to understand that this is a major reason for some of the NHS problems."

This morning BBC Breakfast TV was targetted by Conman following his whirlwind visit to an A&E Dept leaving them in a whirl while saving his wind for the TV audience. I have rarely heard such distortions from a communications man determined to hoodwink the public. His message was that if people know where to go there is no problem with A&E services quoting the failing '111' service, inadequate 'out-of-hours' services and yet to come integrated 'care in the community' provision which is why people go to A&E. Amongst all the NHS upheavals, A&E Depts have become the ultimate points of delivery where other services fail. Louise Minchin didn't sound convinced. Neither was I.

Physician heal thyself!