The future of adult social care

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The future of adult social care

Jeremy Hunt’s Seven Key Principles

In the past 20 years there have been five Green or White Papers, numerous policy papers, and four independent reviews into social care.

Government after government has looked at the situation, decided that something must be done, and then disregarded the advice they were given in favour of doing… pretty well nothing.

Jeremy Hunt, Secretary of State for Health and Social Care, vows that this time it will be different. A Green Paper will be produced later this year, and in the meantime, he has articulated the Seven Key Principles that should be embodied in future social care provision.
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First principle: Quality

It would be a brave politician that didn’t put quality first on their wish list for services looking after some of the most vulnerable people in society.

Jeremy Hunt calls for “a relentless and unswerving focus on providing the highest standards of care – whatever a person’s age or condition.”

He also highlights some of the current knotty problems, which fill our inbox here on a daily basis, as well. Notably 15 minute care visits, when 15 minutes simply isn’t enough time to achieve anything useful. The constantly changing roster of care personnel, leaving clients confused by yet another unfamiliar face at the door.

Vast differences between best and worst care provision across the country, which has led to an incredible 90-fold difference in hospital admission rates for people over 75 from care homes or nursing homes.

Bullying, neglect and lack of respect in some cases.
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Second: Whole-person Integrated Care

This is another way of describing what has been the holy grail of successive administrations: properly joined up health and social care.

Anyone who has had more than the most superficial contact with the NHS and local authority care will know that you very often find yourself dealing with a multiplicity of agencies, explaining your situation over and over again to different people.

Just finding out who is responsible for providing services can feel like an impossible task.

But there are some beacons of light. The Better Care Fund has encouraged closer collaboration and more efficient working locally between health and social care providers.

To make this a more universal reality, the Secretary of State announced pilot schemes in Gloucestershire, Lincolnshire and Nottinghamshire in which everyone who accesses adult social care in the next two years will be given a joint health and social care assessment and – critically – a joint health and care and support plan, if necessary.
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Third principle: Control

Feeling out of control is stressful and upsetting for most of us. Being able to take charge of your own social care arrangements, choosing what services are most important and which providers to use can make a big difference to well-being. Outcomes are better, and costs turn out to be lower, as well.

Although direct payments and personal budgets have been around for some time, older service users are not taking up direct payments to anywhere near the same degree as younger disabled people.

A consultation was announced on Personal Health Budgets, in order to achieve better integration for those with the greatest ongoing social care needs as well as health needs.

And over the next two years in the three pilot areas of Gloucestershire, Lincolnshire and Nottinghamshire, every single person with a joint care plan will also be offered an integrated health and care personal budget.
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Fourth: The Social Care Workforce

How much have we heard about care workers being underpaid, undervalued and poorly trained?

The National Living Wage may have brought a modest improvement in pay, but it would be fair to say that, as a society, we don’t make it clear that providing social care is a valuable and well-regarded occupation.

So nurturing and valuing the social care workforce is one of the seven key principles. As well as encouraging a societal shift in recognition of the essential services provided, this will involve looking at ways to introduce better career progression within the sector, in the same way that the NHS has introduced roles such as associate nurses and nurse degree apprenticeships.

People may well move between health and social care during their careers – even more so in the future, as the two become more closely aligned. So later this year, the government will not be publishing the ‘NHS 10 year workforce strategy’ – it will be an ‘NHS and social care 10 year workforce strategy’.
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Fifth principle: Supporting Families and Carers

The needs of carers should be at the heart of the new social care strategy.

Of course they should, I can hear from many of my correspondents, who are providing care for loved ones and currently feeling very much undervalued and ignored.

Having listened the views of carers, the government is going to publish an action plan to support them, ahead of the social care Green Paper.

They aspire to introduce measures to make it easier to take on caring responsibilities, including more flexible working, better support for employers, and smarter use of technology.

Tackling loneliness is also included in the principle of supporting families and carers; something to which the appointment of a first Minister for Loneliness demonstrates a level of commitment.
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Sixth: Sustainable Funding for Social Care

This could be the rock on which all other principles founder, if it is not achieved.

• The Dilnot Commission Report of July 2011, an honest attempt to make the provision of social care fairer and simpler, made workable recommendations for funding future needs. Despite the situation being described as urgent back then, far from being embraced and acted upon, it was essentially kicked into the long grass and forgotten.

• In March 2017, the CLG Committee concluded that “the need to find a way to fund social care for the long term has now become urgent” and recommended considering using national taxation as a new source of funding.

• In April 2017, the Lords Committee on the Long-term Sustainability of the NHS concluded that reforms were needed “as quickly as practicable” and, on the potential sources of funding for social care, recommended “an insurance-based scheme”.

• In November 2017, a cross-party group of MPs wrote to the Prime Minister, calling for a “cross-party NHS and Care Convention”.

Delivering cost-effective, quality services for all must include a debate with the public on the challenges of sourcing additional social care funding.

Looking to encourage innovation in the social care market, the Green Paper will examine the role of housing, and how appropriate aids and adaptations can improve life at home for older and disabled people.

Harnessing the power of new technology to transform social care is essential, helping people to stay at home independently for longer. A £98 million innovation fund has recently been announced, to support healthy ageing, as part of the government’s Industrial Strategy.

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Finally: Security for All

The seventh principle underlines the importance we place as a society on fairness and equality in accessing healthcare, as witness the creation of the NHS 70 years ago.

We rightly expect that we collectively support people who need help because of illness or disability through the government spending the taxes we pay.

And most of us recognise that it is reasonable and fair for us to contribute to the costs of any social care needs we have later in life, if we have the means to do so.

What is manifestly unfair is the way that families are financially penalised according to the illness a person happens to develop, which is outside their control. For example, if you develop dementia, you are very likely to have to spend a great deal of any savings on paying for care, whereas someone with cancer will face very much less, if anything, by way of costs.

Ideas on how to pool the risks, and spread costs in a more equitable way will form part of the Green Paper.
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Reaction from the Local Government Association

Lord Porter, Chairman of the Local Government Association, said:

“We are pleased to see the Government’s latest detail on how it intends to make adult social care fit for the future, which is one of our most pressing public priorities.

“The ‘seven pillars’ of the green paper reflect what we have long–called for, however, government should resist the temptation for major system reform.

“Councils know what good looks like and, in the Care Act, the sector has legislation that enjoys widespread support and sets out a vision we all aspire to – particularly the emphasis on prevention to help reduce or delay people developing care and support needs. What is missing is the funding to turn that vision into reality.
“While integration is an essential agenda that local government is committed to in order to achieve better health and wellbeing outcomes for people, appropriate funding must be the overriding priority for the green paper and we hope its broad scope will not detract from this focus.

“Government should first make a down-payment on the green paper by injecting additional resources into the system to fund immediate funding pressures which are set to exceed £2 billion by 2020. This will enable the system to stay afloat until such time as the green paper reforms bring in new resources.”

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Janet Morrison, Chief Executive of Independent Age, also commented:

“These principles for a new social care system are what we have been crying out to hear, but these words need to be backed up with far more detail and action. In January, we launched seven key tests for the Government’s green paper, echoed in the Health and Social Care Secretary’s seven principles of reform set out today. However, as well as making care better for the future, we need bold and meaningful action to address the crisis faced by the older people who are using the social care system now. As the Health and Social Care Secretary suggested earlier today, it is a cause for regret that care has worsened because it has been politicised, so we’re calling on all politicians to look beyond party politics to urgently create an integrated health and social care system that ends antiquated, siloed practices and is one where older people can thrive, not just survive.”

Further reading and resources

New Department Of Health and Social Care created

More pondering on social care

Many younger disabled people are affected by cuts to care. See more about the impact care cuts are having here

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2 Responses to “The future of adult social care”

  1. Francis Rutter April 14, 2018 at 5:08 pm #

    A few weeks ago the Government put another few billion pounds towards the health service, without specifying how it should be spent. A lot of the problem of hospital overcrowding is due to the social services not being able to organise care so that patients can leave the hospital. If that money was put into social services then it would be of immediate use to the health service and also help carers and disabled people.

    • Frances April 15, 2018 at 9:34 am #

      Extremely good point you make, Francis – it has always struck me as incredibly blinkered to fund the NHS (albeit to a rather miserly degree), whilst cutting away at social care. The two are inextricably linked, as witness the knock-on effects such as bed shortages and overcrowded A&E.

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