If 2017 was the year social care reform was put on the back burner, there is much anticipation that 2018 will bring the long-awaited green paper with bold, radical ideas to ensure the sector’s sustainability.
Last month, the review finally got the ministerial prominence it deserves when it was transferred from the Cabinet Office to Jeremy Hunt’s department. Here, we hope that this transfer in responsibility may result in the green paper’s focus being broadened.
The focal point of the review – exploring a wide range of options to adequately fund social care – is clearly the paramount issue. In the 37 counties of England alone, there is a projected £1bn funding gap in social care for those councils over the next three years, whilst the provider market has seen an estimated 30,000 care home beds close down over the last ten years as providers’ profit margins dip.
However, the County Councils Network has argued for a more holistic approach to the green paper, which could act as a catalyst for a culture shift towards a more preventative rather than reactionary way of working.
Recent focus on delayed discharges highlights the reactionary nature of the system. Our member councils have worked hard to reduce delayed days attributable to social care by 29% since last February, but we must look to shift thinking towards preventing people from entering hospital unnecessarily.
Housing is an obvious place to start. Enabling people to stay at home and receive care is hampered by the lack of adaptable housing across England, whilst recent analysis suggest that less than one third of the amount of retirement properties needed to fulfil demand are being built a year. For those leaving hospital, there are not enough reablement and rehabilitation services in England.
Increased provision of care housing and adapted properties will allow people to live independently for longer, which should dilute acute demand. We welcomed the government’s recent consultation on supported housing; we argue for a greater role for counties in planning for these homes over a broader geographic scale. Therefore, the green paper should seek to encourage more of this development, and better incentivise providers by reforming the planning system.
The integration of health and social care has long been thought a solution, bringing care closer to the community. It still could yet be – but implementation has been slow and inconsistent across the country, not helped by the financial constraints facing the public sector.
Instead of aspiring for wholesale change in a short timeframe, ministers could consider pooling NHS and social care budgets as a precursor to full integration. Some counties already do; with councils and local NHS providers making joint decisions based around the individual.
Further small-scale NHS reform could also help with the preventative re-focus. For example, the NHS Tariff – which rewards acute trusts for patient contacts rather than outcomes – should be reviewed with the aim of rewarding providers for preventing people from entering crisis care unnecessarily.
County councils also need to work with communities to make them (and the system) more resilient. Our member councils are well placed to lead on this agenda; having sufficient size to make a difference at national and sub-national level, coupled with the intimate local knowledge of their communities to make a difference. This could be through convening and supporting social groups to reduce isolation, or by embracing technological advances to keep people independent, such as Hampshire County Council’s use of the Amazon Echo to help people live independently.
To build a preventative ecosystem we must also widen the debate include tightening the links between adult social care and public health services.
The Department of Health and Social Care taking over the green paper allows the chance to bring prevention into focus, rather than simply the NHS taking over social care, as some commentators have suggested.
County authorities are at the coalface in delivering social care. If this green paper is to be social care’s saviour, counties must be firmly part of the conversation.