The future well-being of millions of older and disabled people requires a sustainable solution for social care. We can’t ignore the inter dependency between the NHS and Adult Social Care and the fact that the overwhelming demand on the NHS needs an accessible, effective social care system.
During a House of Commons (11th Jan 2017) NHS and Social Care debate there were calls for an “NHS and care convention” and a welcome for cross party talks to look at the future of long term care but still much of the 5 hour debate focused on the A& E four hour target.
Dr Sarah Wollaston MP said during the debate “We must end the silos of health and social care. We should stop thinking about money as a social care pound or a health pound, and instead think about a patient pound and a taxpayer pound, and how we get the very best from that”. But given that England has legally distinct health and social care systems, one that is free the other largely means tested it may take more than the NHS five year forward plan and STP’s as according the National Audit Office “there is no compelling evidence to show that integration in England leads to sustainable financial savings or reduced hospital activity”
There is little doubt that the 1.4 Social Care and 1.3 million NHS staff are working their fingers to the bone but missed targets and funding shortfalls usually trigger review and restructure, losing experience and expertise which often costs more than money. The LGA estimates that adult social care faces an overall £5.8 billion funding gap by 2020 and despite a new legal framework, increased Council Tax precept, the Better Care Fund, a £240m “adult social care support grant” the point seems clear, there isn't enough money.
Currently, every patient who goes to an accident and emergency department should be seen in four hours. This applies to all patients from those with life-threatening emergencies to minor ailments. With Hospitals meant to achieve the four-hour target in 95% of cases.
The demographic profile of patients who use A&E departments remained relatively stable compared to previous years. In 2015-16, just under 20.5 million people used A & E departments with 49.2 per cent (10.1 million) of attendances were for male patients and 49.9 per cent (10.2 million) were for female patients (an increase of 4.6 per cent from 2014-15.) Annual A& E statistics Jan 2017 official figures provide details of Accident and Emergency activity in NHS hospitals in England during 2015-16. NHS Digital
2014/15 % 2015/16 %
Total Attendances 19,556,781 100.0 20,457,805 100.0
There were 195,300 total delayed days in December 2016. 56.2% of all delays in December 2016 were attributable to the NHS, 36.0% were attributable to Social Care and the remaining 7.9% were attributable to both NHS and Social Care. The main reason for NHS delays in December 2016 was “patients awaiting further non acute NHS care”. The main reason for Social Care delays in December 2016 was “patients awaiting care package in their own home”
Dr Mark Porter, British Medical Association council chair was clear when he said "When social care isn't available, patients experience delays in moving from hospital to appropriate ongoing care settings - preventing patients being admitted at the front end in A&E,"
Missing the point
For more than 10 years, far from missing the point various articles, reports, commissions, and consultations have suggested and ultimately led to reforming social care law.
Our growing, ageing population needs care. The NHS needs Social Care to keep patients supported and out of hospital. Advice is a fundamental part of prevention as well as choosing ongoing appropriate, affordable, sustainable care and support. But although it is without question at the heart of prevention AND ongoing care and support, information and advice provision has become a menu driven, box ticking exercise. Rather than missing the point, the value of advice is being under estimated and specialist advisers under used.
Joining up the dots
The independent Commission on Improving Urgent Care for Older People recognise the importance of having a single connection within a complex system.
People who are in crisis don’t always have the time or energy to filter through fact sheets or online databases. It’s not surprising that our attention span is affected by fatigue or that interpretation of complicated information is variable (that applies to professionals as well as members of the public!)
We need ‘search and rescue’ advice services not ‘cut and paste’ ones and not because older people can't use a computer but because the care and benefits systems can be both confused and confusing.
A CQC report suggests that “older people and their families or carers did not routinely receive clear information about how their health and social care would be coordinated, in particular if there were changes in their circumstances or if there was an unplanned or emergency admission to hospital”. CQC - Building bridges, breaking barriers: Integrated care for older people
278 registered complaints and enquires about charging for care, 62% were upheld 2015/16 after investigation and highlighting inconsistent information and guidance as causes for concern according to a Local Authority ombudsman annual report
One of the challenges faced by anyone making care decisions, whether it's the person themselves, a spouse or family member is the emotional impact of a crisis situation and the added pressure to make a quick decision with little time and no previous experience of the care and benefit systems. Confusion and frustration is caused by a fragmented system with no clear pathway for personalised care advice and a missing link between regulated and unregulated financial advice. This imposes a reliance on services that are not intended to provide financial care advice and restricts access to the appropriate specialist advice needed for people to make fully informed decisions. Unsupported provision of information and advice wastes an opportunity to maximise income, delay reduced funds, promote financial capability, and ultimately save money.