By Jane Ashcroft CBE, Chief Executive , Anchor
Both local authority commissioners of social care and Clinical Commissioning Groups, set up to organise the delivery of NHS services in England, are facing an unprecedented demand from Britain’s ageing population.
In the NHS, the “winter pressures” typically experienced in hospitals are increasingly a year-round phenomenon. Largely, this is because too many older people are going into hospital with preventable issues and remaining stuck there even when they no longer have a medical problem.
Local authorities, seeing their social care budgets squeezed, are restricting care and support to only those with the most serious need. And, after some nifty Spending Review footwork by the Chancellor, they will need to raise taxes at a local level if they want to do more.
So councils and CCGs need to work together to keep the good ships of social care and health afloat so that older people get the services they deserve.
Spending on social care saves money for health – by reducing the number of people going into hospital and getting them out more quickly. But, with separate budgets for health and social care, there’s little incentive for local authorities to spend in order to save money for CCGs.
Some forward-thinking areas are doing things differently – but they are few and far between. At Anchor, we have been working with Birmingham City Council and Birmingham CrossCity Clinical Commissioning Group to provide reablement beds.
The initiative, running at our Kerria Court care home, means people who would otherwise be stuck in a hospital while their social care needs are sorted out are instead able to move into a care home for a few weeks. A care home bed is significantly cheaper than a hospital bed so, as well as being a better environment for people, it saves significant sums for the NHS. It also helps people recuperate and get back into their communities.
According to local government think-tank Localis, which featured the initiative in its report “Unblocking: Securing a health and social care system that protects older people”, it has been estimated that it costs £1,610 to have a patient in a rehabilitative hospital bed for a week. A care home bed can be significantly cheaper and, as we have shown at Leofric Lodge in Coventry, the same concept can also work in a housing scheme.
But, as Localis found, the health and social care system still rewards activity – not outcomes, so undermining attempts to focus on the successful management of long-term health conditions. In fact, we financially incentivise disjointed care with short-term budgets that inevitably end up being concentrated on short-term pressures in the system, rather than thinking afresh about how to prevent illness in the first place.
UK healthcare does not do enough to prevent avoidable injuries for older people and is conditioned to keep older people in hospital longer than they need to be there. And, too often, relationships between partners delivering care remain poor.
While our work in Birmingham and Coventry are examples of how housing and care providers can save money for the NHS by tackling delayed discharge from hospital, they can also reduce the number of people going in in the first place. There’s strong evidence that retirement housing reduces the likelihood of people needing hospital care.
Challenging the government and health service to think differently is one way to meet the issues of Britain’s ageing population. Another is to professionalise the care sector so that more people, particularly more young men, consider care as a career.
As England’s largest not-for-profit provider of care and housing for older people, Anchor is leading the way, having launched the Anchor Apprenticeship Academy last year. More than half of the apprentices have secured full time roles within their care homes, with the rest set to secure roles as soon as they become available. And our second intake of 30 apprentices begins in March.
Training is key but so, too, is recognising the hard work the apprentices and other care colleagues put into this crucial work. Once they have achieved their Level 2 Intermediate Apprenticeship in Health and Social Care certificate, they will be receive a living wage in line with the Living Wage Foundation which ranges from £8.40 to £9.15 depending on where they work.
So there’s no need to abandon ship, we just all need to work and think differently, and have strategies in place to navigate the choppy waters.