After months of waiting, we saw a plan to ‘fix social care’ but, before we get too excited, we have to consider and agree what we are fixing, and to do that we have to understand what social care is and what it delivers. How can we fix something which is not clearly understood by those who are constructing the plan or indeed funding it? The view that social care addresses social needs only is outdated and must be challenged. So, before we can progress to contemplating how it is fixed, we have to understand how and why it ‘broke’!
The role of social care historically, has been to support people when they can no longer safely live alone at home or with those who cared for them. Their needs may be such that there is a risk to their wellbeing which does not require acute health intervention and can be managed within a social care support network. A network which is a rich and diverse patchwork quilt with wrap around services to create a safety net.
The reality is that over the past decade, due to the pressures on the NHS, social care has evolved into a healthcare service by default but with none of the recognition or the funding required to support the vulnerable people who are cared for through it. Notably, through the pandemic care homes found themselves delivering care in a way that was completely outside their remit or comfort zone, but they did it. There has been no acknowledgement of the added skills required by our teams or the infrastructure changes to support the client groups let alone the training needs of those delivering the services. Where once end of life care, stroke recovery, dementia/Alzheimer’s, challenging behaviour etc. were seen as conditions which would be treated in NHS setting, we now see them being supported in the social care framework but not funded in line with NHS settings.
Social care is a much more agile and responsive service than the NHS, where the NHS’ focus is to treat the medical needs of an individual, whilst social care aims to support individuals towards leading as independent and fulfilling life as they can. The systems are two sides of the same coin playing a critical role in the wellbeing of our citizens, but the mindsets of the two sets of professionals are a world apart. They should complement and support each other, but that is not addressed by the plan.
As things stand, we struggle to get a person-centred pathway from acute care to social care without seeing a dramatic reduction in the funding available to support the individual. We see evidence of inappropriate discharges out of hospitals into social care to ease the pressures on the beds, demonstrating that there is no emphasis or evidence of a ‘person centred care’ approach. We are allowing the erosion of a robust and vibrant social care solution in an effort to prop up an ailing NHS service by throwing money at the problem without due consideration of an investment in social care which could provide the solution.
The importance of understanding social care is critical when creating a sustainable plan: it remains an under-valued and underfunded sector but critical to those it serves. Despite substantial private investments with continual evolutionary offer of the services, it has been hampered by a lack of a strategic plan.
It is absolutely right for government to focus on the workforce plan; the sector has been raising this issue for a decade at least. The concern will be, is it too little too late? What is unacceptable is that the governments plans are for a vision for the future despite the fact that the crisis is here now. A promise of £500 million in the future is not going to fix a crisis which providers are living and breathing today!
There can be no doubt that any sustainable plan has to consider the enormous challenge of recruitment and retention. We know the impact of the pandemic has led to an acceleration of the staffing crisis and mandating vaccination for care homes has had a devastating impact. The option to take time to inform and persuade our valued workforce was taken away by this legislation leaving a small but critical minority of our teams to choose to leave and take roles in the NHS or other sectors where mandatory vaccination was not a barrier to employment.
There is no doubt in my mind that the governments ‘plan’ is focused on the recovery of the NHS with all roads and funds leading to that end, it is not about ‘fixing social care’. This is understandable, based on the importance of having a strong and sustainable NHS to respond to the needs of the citizens of our country, however without addressing the decades of neglect of social care it will be yet another sticking plaster.
A plan without a strategic vision and one that needs to fit into an envelope of funding is not a plan. The increase in NI to fund the plan will have a direct impact on our workforce and businesses themselves. This plan also has an unrealistic timescale to address the issues bearing in mind the crisis it seeks to address is already here.
What we need is a plan that centres on the crisis now, addressing the impact of the pandemic and the government’s own contribution to the crisis by mandating vaccinations. Without a confident and competent workforce who are valued, supported, and renumerated properly we cannot and will not deliver anything and the NHS will not recover. The medium term must address what we expect from social care and how that can be funded through a model which looks at care needs mirroring the assessments made collectively by NHS professionals in dialogue with social care professionals, the individual and their loved ones – a multi-disciplinary approach which sits on the edge of integration and sustainable funding of what the social care offer looks like.
Any plan must look at social care through the lens of its value to those who receive and deliver it, whilst recognising those who invest in it. It must also acknowledge that social care contributes over £50 billion to the economy and supports the NHS to deliver the services they need to. Social care services are the solution to fixing the NHS, but sadly this seems to have escaped the decision makers who remain in the mindset that it’s the problem that needs fixing.