Mind the gap: between health and social care
We are on average living much longer. The Government needs to urgently address how to provide care and support to a growing number of people.
The Prime Minister and Chancellor on taking office had perhaps not expected to find themselves in the depths of a crisis in the NHS so soon. With Brexit taking up much of their attention on the international front, the NHS continues to dominate domestic concerns.
But the solution lies not just in a short-term injection of cash but in finding long term solutions to providing care and support to those who need help with daily living.
We are on average living much longer. As the post war baby boomers turn 71 the numbers of people needing care and support will grow over the next decade. The Government needs to urgently address how to provide care and support to a growing number of people.
More people are falling through the gap as the NHS retrenches to focus on acute care while local authorities concentrate their reduced funding on fewer and fewer high need people. The lack of capacity and funding for community health care, intermediate care and social care means people get stuck in hospital waiting for assessment, decisions about care packages and who will fund them, or for adaptations or modifications to be made to their home. During this time, they are in an expensive acute bed, at risk of decompensation (a horrible word that basically means they lose mobility and the ability to function, i.e. go to the toilet, wash themselves). Staff are not available to mobilise them, no one is focusing on rehabilitation or getting them up and moving. This deterioration in their condition often means that they can’t return home, thus becoming permanently dependent and disabled.
This is a false economy. The NHS and social care divide must be bridged. There needs to be a joint responsibility for getting the best outcomes for people. This means having an active focus on maintaining and restoring function by health care teams even while someone is in hospital. It means working closely with housing providers to get necessary adaptations and modifications made to people’s homes quickly and efficiently without waiting for assessments and approvals or struggling to get reputable tradespeople. It means supporting the 1.2 million unpaid family carers without whom many more people would be reliant on statutory services. It means mobilising more people in communities to provide low level help and support to neighbours.
So it’s vital that the government makes some bold political decisions that will set the course for putting care and support on a sustainable footing. They should start by addressing the short-term funding shortfall but also set out major reforms to define what care and support we can expect to be funded by the state.
The Centre for Ageing Better’s research found that good health was cited as one of the most important factors in having a good later life. And in our survey of people aged 50 and over, nearly one in four said they were worried about becoming less mobile. Everyone should have the care and support they need to be able to remain in control and enjoy their later life even if they face limitations in their ability to carry out activities of daily living. As the WHO have made clear, healthy ageing is not about being disease free but being able to function and live life to the full. This also means homes and neighbourhoods that support people to do as much as possible despite their physical or cognitive limitations.
It has always surprised me that despite many people experiencing challenges in accessing care and support for themselves or loved ones the issue has not been higher up the political agenda. The council tax hikes that many councils have recently announced are set to hit people from April this year. These additional revenues will go some way to dealing with the funding shortages but those areas most heavily impacted by cuts to central government funding are also those with fewest self-funders and hardest to generate revenue from council tax. This will further worsen the post code lottery in care.
As more of us live longer and survive diseases that would have killed us in the past, we need new solutions that bridge the historic divide between the NHS and social care to give us control, dignity and quality of life in our final years of life. Short-term bailouts will only delay the crisis. We urgently need a long-term settlement to bridge the historic divide between NHS and social care and that recognises the changing needs for care and support of an ageing population.