Yesterday after collecting both written and verbal evidence, the House of Commons Health Select Committee published their report into Social Care.
It makes very interesting reading and is written accessibly so I would highly recommend that anyone with an interest in this area reads the original but I wanted to pick up on some of the themes myself as there were such crucial issues raised.
The main theme I picked out (and you don’t have to be very astute to click with this one!) is the need for continued work towards integration – not only between health and social care which has become a bit of an old chestnut, but also with social housing.
The figures the report pulls out are that 50% of GP visits and 70% of hospital days are required by older adults as well as half housing association tenancies.
It’s not surprising but when we think about these figures, it is very important to put them in the context of need and service delivery rather than indicate that people who have additional needs, whether due to age-related disabilities or other illnesses or disabilities are not a ‘burden’ or a ‘problem to be solved’.
The problem absolutely lies in the way that these services are both funded and commissioned rather than the additional needs that exist, after all, we can hardly say, in 2012, that an ageing population with higher health and social care needs has hit society suddenly without notice.
It is a lack of political (and fiscal) will to change that creates the poor delivery of service, not merely the numbers needing additional care.
The report criticises the ‘silo thinking’ of these different agencies, particularly local authority ‘social care’ funding, NHS ‘health’ funding as well as housing and provisions of benefits. All live in their own splendid funding isolation where there is a distinct benefit to the individual budget holders to push costs from one siloed ‘pool’ to another creating a more complex, detached and poorer service for the end user.
So, the report looks to joint commissioning as an answer, particularly suggesting a single commissioner with a responsibility for older adults in particular across all these layers of services.
I understand the intention and see it as an improvement but I feel there needs to be greater innovation in this approach. I have little faith in commissioners that work within the services I have to dole out. They never seem to have any interaction with the service users/carers/professionals at the ‘front line’ and provide poorer quality services at yes, lower cost, because they are not the ones who have to receive those services.
The Committee scoffed at Burstow’s claim at there is no funding crisis in social care.
there is clear evidence of resource pressures on social care authorities. The Committee welcomes the Government’s commitment of an additional £2 billion per annum to social care by 2014-15, but recognises that even this substantial additional commitment is only sufficient to meet additional demand if social care authorities are able to deliver an unprecedented efficiency gain of 3.5 per cent per annum throughout the spending review period and does not allow for any progress in responding to unmet need.
The report also raises the joint issue of quality of care as well as cost of care as the two go hand in hand and current commissioners have to take some responsibility for that
The Committee’s response to changing the funding system is broadly in line with the Dilnot report with some caveats around the levels of the proposed ‘cap’ on payments and whether this may discriminate between areas of the country where costs (particularly housing costs) are very different and they state that while this may solve one area of the current difficulties and muddled thinking – it is by no way a panacea.
They have an interesting few paragraphs about personalisation and the roll out of personal budgets, emphasising the possibilities to make care more flexible however the realities of the levels of budget can sometimes belie expectations. There is also a warning.
A growing number of people are having their care needs quantified and converted into a sum of money through a resource allocation system (RAS). This creates a scenario in which people’s needs could be assessed less personally and could develop into an entitlement-based system which awards them a specific cash amount under a process more akin to social security than social care.
Something to be mindful of as the RAS comes under scrutiny at the Supreme Court
It’s an interesting and useful report and as I said at the start, definitely worth reading for an overview of some of the challenges that face adult social care currently.
I’d like to see more innovative approaches to building new systems. It feels as if social care is often slower than other areas to change because some of the monolithic systems within local and central government have ‘been that way’ for such a long time.
The world is changing. The Personalisation Agenda reflects the move into a post-modern climate of care delivery but the systems remained couched in the modern origins of the welfare state. Until there is more movement from commissioning and service delivery, the talk will mean nothing. While I am hopeful by some of the suggested changes, I look to the government who denies there are any problems in funding and despair.
We need to change and at least the committee recognises that although it’s hardly ground breaking. The need for joint commissioning strategies, linked in outcome measures and cross pollination of money/ideas between health and social care is hardly new.
No government wants to jump because powerful interests and lots of money is at stake. Hopefully more and more reports will finally lead to something being done differently and better.