In the waiting room with social care
Health and social care secretary Jeremy Hunt gave a speech to the British Association of Social Workers on Tuesday and gave a broad map of ideas which will underpin the Green Paper on reform for social care for older adults.
The Seven Key Principles
- Whole-person integrated care
- Supporting families and carers
- A sustainable funding model for social care supported by a diverse, vibrant and stable market
- Security for all
The Big Question
Will this do anything? It is worth waiting until the Green Paper is published “before the Summer” for specific details, however the Health and Social Care Secretary gave little away in his speech. He conceded he feels the weight of stalled reform programmes on his shoulders and accepts shared responsibility for the lack of progress made by the Conservatives since their entry into government in 2010.
So back to the big question. What is happening with this Green Paper that will make the necessary changes to the sector in order for it to survive in its current form? As mentioned in his speech, there will be an extra million over 75s in 10 years’ time, so will these changes make any difference to an already struggling sector? The short answer is, we will have to wait and see.
Examining the Principles
Firstly, the issue of quality was described as “not of the quality we would all want for our own mum and dad”. On the basis of ongoing reviews commissioned by the government for the CQC, the Green Paper will propose CQC-style ratings for local commissioning of care services. Will adding a further layer of bureaucracy assist the government in bringing about a higher level of care for service users? The question also depends on money. This process will surely slow down the commissioning of work for providers to bid for, and will take up further time, and therefore money for local authorities.
The report from the National Audit Office on the financial stability of Local Authorities 2018 confirms the suspicions of the sector about the funding of social care services. Two thirds of Local Authorities with social care responsibilities had to draw on their financial reserves in 2016/17, and it is not surprising current trends confirm the financial unsustainability of this in the medium term. The National Audit Office have reported on the increasing demands and costs of services and have said that 1 in 10 councils with social care responsibilities will have exhausted their reserves within the next three years if the current rate of expenditure continues. The National Audit office concludes Local Authorities are nearing the end of their ability to make further service savings without impacting on front-line services. So, while additional quality measures are welcome generally, here the government need to make sure they remain cost effective and don’t add further expense to already-struggling Local Authorities.
Secondly, the secretary announced the movement towards integration of the NHS and Social care, and announced radical pilot schemes in Gloucestershire, Lincolnshire and Nottinghamshire, under which, over the next two years, every person accessing social care will get a joint health and care assessment, joint care plan where needed and a joint personal budget. Movement towards integration of Health and Social care seems to signify the general shift in ideology, as Service User experience of dealing with agencies in both health and social care has sometimes been negative due to poor service coordination. We will have to wait and see how these pilot projects pan out, however this step is positive for Service User interaction with services.
Thirdly, control was well received by his audience on Tuesday, and for Service Users, choice and control is certainly a positive aspect of modern social care. This is just a reinstatement of a shift which had begun well before this year and is not really anything innovative which will benefit the entire sector in a systematic manner. Whilst positive, this third principle isn’t exactly earth-shattering.
The fourth principle addressed is Workforce. The Health and Social Care Secretary pledged to promote social care careers and pathways into nursing and committing to a new, fully aligned 10-year NHS and social care workforce strategy. We will have to wait and see what this strategy details when it’s released fully, as the difficulties surrounding recruitment in the sector are serious. It was only last month when the National Audit Office published a report which concluded that the Department of Health and Social Care is not doing enough to support a sustainable social care workforce. The department estimates that workforce will need to grow by 2.6% every year until 2035 to keep up with expected increase in demand with a rapidly ageing population. One of the most pressing issues with attracting these additional numbers is Brexit. Historically, social care has been an attractive prospect for immigrants from the EU, however this has slowed significantly since Brexit. 10,000 EU nationals working as doctors, nurses and support staff reportedly left the NHS in the year after the Brexit vote. Historic retention issues in the sector will be difficult to rectify, as pay remains low, people see retail as a more attractive employment prospect than social care. Realistically, wages can’t be increased to a high level to persuade people that social care is the better prospect, as the question of finances is the single largest threat to the sector in its current form.
Families and carers
The fifth principle was accompanied by a quote from president Ronald Reagan – “the nearest thing to eternal life we’ll ever see is a government programme”. This principle concentrated on the supporting of families and carers, and he affirmed his commitment to a carers’ action plan to appear ahead of the Green Paper. This is once again a wait and see situation, as this is fairly vague at this stage.
Anxious wait for the Green Paper
Overall the speech left us with as many questions as answers, and once again there was no mention of a funding boost. However, there are positives to be taken, and we hope the Green Paper will provide answers to problems facing the sector as a whole. As ever, patience and vigilance will be required from those of us operating within the field.
In the meantime, if you have any social care business support needs, give us a call here at Insequa. We promise we won’t make you wait any longer than is necessary for expert Tender Writing, CQC Inspection Support, Compliance Software and Social Care Policies.