Social care in England is totally broken, gasping in intensive care. Councils have made substantial productivity gains for two decades, and six years of austerity has seen the spending power of local authorities reduced by 40 per cent. Social services have been squeezed so substantially that the sector is now at tipping point. It is no surprise the number of vulnerable people being helped by local authorities is rapidly decreasing, despite the increase in those who require it. Two recent cases illustrate what’s happening to social care in the community.
Iris Sibley was trapped in hospital for six months. She was a delayed discharge on a ward at Bristol Royal Infirmary because the community health care provider tried but failed to find her a suitable nursing home place. Meanwhile, a multiple sclerosis patient at a hospital in Manchester was left waiting for 295 days for a nursing home placement as cuts to adult social care have left hundreds of thousands of vulnerable people unable to access the care they need.
Barely a day goes by without more tales of woe in the headlines. Elderly people are ending up in the back of ambulances because the support that helped them live independently at home has disappeared. They are spending weeks or even months in hospital because there are no care homes into which they can be discharged.
Figures reveal that nearly three-quarters of NHS trusts had seen patients stranded for more than 100 days in the past three years. Nuffield Trust, a health think-tank, has said the number of patients trapped in hospital despite being fit to leave is three times higher than official data shows. Sir Robert Francis QC who produced the damning report on the Mid-Staffs scandal has voiced his concern, saying that the NHS is facing an “existential crisis” and measures in the Five Year Forward View and sustainability and transformation plans are “unrealistic”. The worry I have is that when patients stagnate on wards, other risks accrue, such as infections, falls and even neglect due to poor morale of staff.
It is clear now more than ever that chronic underfunding is not only preventing NHS staff from providing patients with the level of care they deserve, but is the most important cause of the NHS and social care crisis. The biggest pressure on A&E and GP services is due to social care cuts. For many trusts, the social care crisis is pulling them further underwater. The Health and Social care system is a mess and the collapse can be tracked back to the Cameron-led coalition government’s persistence with Lansley’s NHS reforms and Chancellor Osborne’s austerity economics. Net expenditure on social care has fallen in real terms from £8.1bn in 2005-06 to £6.3bn in 2014-15, a drop of more than 20%.
Care homes in England are closing at an unprecedented rate; the number in England has fallen from 18,068 in September 2010 to 16,614 in July last year. At a time of growing need linked to the ageing population, hospitals are logjammed, with many elderly patients having nowhere to go. In the community, local authority cuts are leaving more than a million people desperately in need of more assistance in their homes. Poor areas where residents do not have homes to sell and where care homes are almost entirely financed by local authorities have seen the most closures.
The Prime Minister’s and Chancellor’s stubborn approach to health and social care funding is playing havoc with people’s lives. The PM cannot continue to bury her head in the sand and ignore the crisis. The government’s refusal to find any new money for social care is inflicting significant and lasting damage on the NHS and the lives of patients.
What’s the solution? The government must urgently look at the long-term funding, capacity and recruitment issues facing the system as a whole. Social care and health care must be better integrated. Any feasible solution will involve a mix of public, voluntary services and private provision, coupled with public funding through higher taxes. Politicians of all colours must set aside ideological differences and work towards pragmatic solutions before it is too late.
In my view tax must rise, on the lines proposed by Andy Burnham when he was health secretary. Social care should be treated like the NHS. I think it is right that society takes collective responsibility for care costs, in a way that will give people peace of mind and allow them to plan properly for later life. For this to be affordable requires a care system in which everyone makes a ‘fair care contribution’.
Calls for an increase in social care funding in the autumn statement were ignored by chancellor Philip Hammond. I have little hope for Budget 2017 on March 8, as we go to press. The Health Service Journal has revealed the Care Quality Commission is to be handed regulatory oversight for how councils manage social care services, and there is speculation there will be a modest increase in care funding, but any such package would only be a sticking plaster. Social care is broken, and the Tories don’t intend to fix it! That failure may in time define this government as much as Brexit.