Liz Jones, Policy Director at the National Care Forum, explores the critical shift from hospital based care to community led support.
The government’s ambitions to shift the focus of effort and resourcing away from the acute hospital sector into the community sector are laudable; many governments have had similar ambitions though, so it does feel rather familiar.
This shift will only be achieved if the government recognises the critical interdependence between social care and health care, not just in relation to hospital and health system pressures but also the wider, more important purpose of social care which is to support people to live as independently as possible, in the place they call home, living the best lives they can.
Care and support services play a vital role in early intervention and prevention, and part of the shift the government wants to achieve has to be focussed on reducing the barriers people and their families face to get timely access to care and support, be that homecare for older people at an earlier stage to promote safety and independence at home before crisis hits or be that community based services to support working age adults build confidence and skills or to prevent social isolation and loneliness. Here at the National Care Forum, our members are all not-for-profit providers offering a very diverse range of care and support services which form a wider ecosystem for their local communities. This brings several opportunities for the government: the support our members offer is instrumental in improving population health outcomes and reducing the burden on the NHS and other public services at an earlier stage. Alongside this, they have deep insights into current and potential future needs of people in local communities. This comes as a result of their origins, which are rooted in local areas, alongside their focus on person centred care.
The barriers to this shift from reactive hospital care to proactive community-based support are well rehearsed – lack of investment in social care, (money & resources), the power imbalance, culture and assumptions, poor understanding and perception of care and support and the fundamental challenge of changing big systems.
But there are things that can be done now to shift the dial. To govern is to choose, we are often told, so we must all continue to press the government to shift its investment from acute health into social care. More immediately we need to Treasury to either exempt the sector from the employer National Insurance Contributions increases or guarantee the ring-fenced funding to meet these costs. The Nuffield Trust has estimated the additional unfunded costs of the Budget to the sector at £2.8bn next financial year, putting many organisations at risk of closing and ultimately impacting the care and support for thousands of older and disabled people
The government’s ambitions for a National Care Service and a Fair Pay Agreement for social care offer a potential avenue to shift the imbalance of power and the challenge around perception of social care. A National Care Service must offer a clear public identity for adult social care that is as recognisable as the NHS and which helps people understand what social care is, what it does and how to get it. The Fair Pay Agreement has the potential to help us transform the pay terms and conditions of our workforce – the big BUT here is that it must be properly funded; failure to do so will be the betrayal of the flagship policy for social care.
Technology is a vital ingredient too, be that extending the digital maturity of the care sector to free up more time to care or investing in tech to support choice and independence at home. Improving data flow would support people’s journey though health and care while deriving better insights from our collective data could shape future models of care and support and enhance early intervention and prevention.
Thinking of the wider system challenge, social care providers need a strong voice in those systems, distinct from local authorities; it really is time to have funded roles to enable the representation of adult social care providers on the membership of every Integrated Care Partnership and to require that Integrated Care Boards have an Adult Social Care Lead to ensure correct a tendency for systems to see everything through a healthcare lens alone.
Fundamentally however, this shift needs a transformation in the power relationship between health and social care that can only be led by government.
