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What Keeps Me Awake at Night…Dr Christopher Handy OBE

Dr Christopher Handy OBE, Chief Executive, Accord

Continued economic focus on austerity has created a crisis in health and social care. This crisis will undoubtedly escalate. It is already at epic proportions. Despite some political rhetoric to the contrary austerity continues unabated. Local authorities are starved of essential funding, causing people needing care in the community to be “blue lighted” into hospitals. Many hospitals over the last year have been at winter pressure levels even during summer months. Vulnerable people need care in their own homes to prevent trauma and unnecessary suffering. Care in the home or close to the home is being denied to the people who need it most.

A number of factors coincide in making this situation far worse. Firstly, population level factors are at work; our aging population is now expanding due to baby boomers reaching retirement years. Perversely the quality of acute medical services is keeping people alive for longer compared. Therefore, there is a much bigger older population driving up demand for health and care services.

Secondly, there has been significant behaviour change over the last couple of decades where so much that was once part of family or social life has been medicalised. Death is now a clinical rather than a family event. This puts additional stress on already stretched services. Not only do hospital staff have to handle a death, but they also have to support grieving families, which takes them away from their crucial acute care roles. Surely the right kind of care package in someone’s own home would eliminate the need to hospitalise people at the end of life. This requires social care and sometimes health care services being delivered to people in their own homes rather than in a hospital setting.

Thirdly, health and social care, especially the latter, are not seen as attractive careers paths. We have serious shortages of staffing in a number of health care disciplines, nursing and GPs are just two examples of many. But pay levels in social care for care workers, those very skilled people who support people to live independent lives in the community, are derisory and completely undervalued. At, or close to, national living wage pay levels do not attract sufficient numbers of people into delivering social care on the ground. Instead local authorities have had to keep hourly rates as low as possible due to lack of financial resources. Thus an essential service to the most vulnerable of society is reduced to low paid, often purely part time work. There are many very dedicated people doing a heroic job in social care despite these unfair working arrangements.

And finally, although there are myriad of other complicating factors, austerity as a major governmental policy has shaped the health and social care agenda in a number of ways. Limitations on local authority and central government spending has placed pressures on services which have, in turn, both shortened and narrowed the lives of the most vulnerable people in our society. It is no coincidence that the plateauing of life expectancy for the first time in decades has occurred during this period of politically imposed austerity. It is also no coincidence that we have more visible street homelessness which has partly resulted from cuts to welfare benefits, with the introduction of benefits caps and the roll out of universal credit. Life expectancy for someone who is homeless is only 60% of that for the rest of the population.

Disappointingly the Green Paper on Adult Social Care, which is a crucial component to delivering the long term plan, has still yet to be published – in fact it has been delayed yet again.

The ambitions of the NHS delivery plan will not be delivered without a robust and well-funded social care system.  


Edel Harris





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