Opinion

What keeps me awake at night

Sarah Pickup, Deputy Chief Executive, Local Government Association

Sarah Pickup, Deputy Chief Executive, Local Government Association

In 2015/16 the Care Quality Commission said that “we may be approaching a tipping point”. They were referring to the combination of a fragile adult social care market and pressures on primary care and the impact of this on secondary care performance – all in the context of a growing and ageing population, more people with long term conditions and a challenging economic climate.

It was almost as if they had a crystal ball, all that was missing was a pandemic, war in Ukraine and a cost of living crisis.

It feels as if we have been teetering on this tipping point since then, sometimes frighteningly close to the edge. Yet in this same period there has been much talk of reform and of “fixing social care” and there is a much greater awareness and acceptance of the interdependencies of the NHS and social care and refreshed ambition to integrate around the people who need support and to focus on reducing health inequalities, prevent the escalation of need and improve population health.

One question is what is meant by “fixing social care” and much of the political focus has been on tackling the issue of the cost of care individuals, particularly those facing catastrophic costs by the introduction of a cap on the cost of care as well as more generous capital thresholds for charging.

Yet there is so much more to fix.

A White paper, “People at the Heart of Care” set out a 10 year vision for social care in December 2021 but successive changes in government, as well as the arrival of double-digit inflation, have delayed progress and led to the deferral of the implementation of charging reform and a revisiting of priorities for spending..

There are amazing and dedicated people working in the care sector but in every part of the system people are so busy fighting fires that there is little time to stand back, join with partners and look at how we could and should change. In places there are innovative practices and new ways of commissioning, enabling or delivering support but to make this the norm councils, care providers, voluntary and health sector partners and people who draw on support need time to work together and redesign the system so that it is fit for purpose in the future.

This needs pump priming but it also needs long term funding solutions which can deliver better support to unpaid carers and allow staff pay to better reflect the skilled nature of the work and the value to society and the development of support that will deliver the best possible outcomes for people and communities    I think there are 3 particular areas of focus that could take us towards this better future:

  • We need to ensure that people can access information and advice and preventative support and that this is actively promoted and targeted where appropriate based on assessed risks to individuals and in communities.
  • In addition we need to make sure that, if people need health or care interventions , that there is a focus on recovery or enablement with support focused on achieving this.
  • Finally, for people who need to draw on longer term support this should be designed with them, around their needs to use available resources in the best possible way.

There is a lot of agreement about the need for investment and reform but, after years of delay the scale of investment needed to deliver a better vision of the future poses a major challenge to government and to society. It is a challenge we will need to rise to if we want to step right back from that tipping point to a new equilibrium.

Kirsty

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