Professor Martin Green, Chief Executive at Care England sets out the urgent need for reform in the social care sector and the shift towards greater independence from government reliance.
The social care sector has been under attack from the moment this government entered Downing Street. Within three weeks of taking power, they abandoned the reform agenda and abolished the workforce development fund. After years of underfunding, we had a blow in the budget for increased NI contributions. To add insult to injury, the NHS was given an extra £23.5 billion with very few strings attached regarding how the money would be spent.
This money could have made a great difference if it had been delivered for outcomes to citizens rather than just being pumped into a dysfunctional organisation. As well as getting all this extra money, the NHS also got exemptions from the NI contributions, and this follows years of double standards and the way in which successive governments treat health and social care differently is both undeniable and defies understanding. We saw it in the previous administration, when they singled out social care for changes to the overseas visa requirements but allowed the NHS to have the luxury of staff bringing in dependents. The result of this was an enormous decrease in the number of overseas visas being allocated for social care.
The knowledge that we will have this government for probably 10 years tells us that we have, as a sector, to grasp our own future and start finding ways of weaning ourselves off government contracts. What we need to see is the government realising the importance of social care, and that will never happen until we stop engaging with them and find other ways to deliver social care services without the heavy reliance we have on public funding.
This will require care providers to be radical in delivering their services and start thinking creatively about changes to the model. We also must embrace new technology and find ways to make our services more efficient.
It is particularly outrageous that older people who fund their care are being forced to subsidise the government because of its inadequate funding. The care sector needs to make much more noise about this because, in effect, these people are being double-taxed. Having paid into the system for all their lives, they are now being told that they not only have to pay for their own care but they are being used as a way of propping up in an adequately funded public system.
One of the first ways we need to prove social care in the future is by trying to engage people who use care services, their families and friends, and the 1.6 million people working in the sector. I have lost count of the times politicians have told me they never hear about social care. We need to change that because unless we get a groundswell of support from the general public, we will not be able to raise the profile of social care.
One of the ways services can be more sustainable is to start thinking about how they engage service users at the earliest stage. I believe care providers need to change their model, engage with people in the community, and find ways of using direct payments to fund some new services based on residential care. What is good about using direct payments for some services is that the individual controls the decision about where they want to spend the money. This reduces the power of the local authority commissioners. Engaging people and supporting them with advice, information, training for unpaid carers, respite, and enablement services is a good way for care providers to develop their business model.
It is disappointing that despite the extra money going into the NHS and the arrival of ICS, there has been a real reluctance for the NHS to spend any money outside its organisation. This year, we have seen a drastic reduction in the number of winter pressure beds that are being commissioned. At a recent Board meeting round the table, we were in excess of 60,000 beds, and we discovered that 15 NHS winter pressure beds had been commissioned.
If social care is going to be sustainable, we must invest some of this extra money from the NHS budget in services. If we are commissioned to do so, we can deliver more cost-effective and better outcomes for many people, but this will require us to make much more noise when we see pressures in the NHS and know we have the solutions.
The new government will treat social care like previous governments of all political stripes have done. We are seen as a peripheral service, but this is not true. The 20th century is characterised by long-term conditions, many of which cannot be cured, and it is social care that supports people with those conditions to live well. Social care should be seen as a part of national infrastructure, and our future depends on us being creative and dynamic, embracing technology and improving efficiency. We also need to get a higher profile and be more demanding. The coming years will be challenging for the care sector, but I know it will come through because it provides vital support to citizens. However, I would warn the government not to take us for granted because if we are not there, the whole of the NHS will collapse, and that will be the fault of the government, not the care sector.
@ProfMartinGreen @CareEngland
