The challenges facing the social care system are rooted in years of underfunding and delayed reform, which the government has committed to addressing. But continued delays are leaving more people without the care they need and adding pressure across the health and care system, including NHS services.
Over the past decade demand for health and care services has increased, largely driven by an ageing population, people living longer with co-morbidities and long term conditions, and a rise in the number of working age adults with care needs. The pandemic has heightened the pressures both the NHS and social care faced previously with demand rising sharply in the context of constrained finances and workforce shortages.
Two sides of the same coin
It is well known that NHS services rely on a stable, sustainable social care system to support people to remain well and independent in the community. This prevents unnecessary hospital admissions prompted by social isolation and falls. If the social care system does not have sufficient capacity, there is a direct impact on demand for NHS services and patient care.
Yet cuts to local government budgets have forced local authorities to tighten the access criteria for publicly funded social care services, resulting in high levels of unmet or under-met need and further increases in demand for NHS care often when people reach the point of crisis. 83% of trust leaders are worried or very worried that sufficient investment is not being made in social care in their local area (NHS Providers, October 2020).
Social care also plays a key role in ensuring people can return home with a care package or to a care setting as soon as it is appropriate after a stay in hospital.
Co-Director of Development and Engagement
Social care also plays a key role in ensuring people can return home with a care package or to a care setting as soon as it is appropriate after a stay in hospital. Timely discharge and a "home first" approach are not only better for individuals – as unnecessary hospitalisation or delayed discharge can lead to deconditioning and deterioration physically and in terms in people's mental wellbeing and independence – they also support patient flow through the health and care system, which proved critical during the COVID-19 response creating hospital bed space for those patients who really needed it. Both health and social care colleagues welcomed the suspension of NHS Continuing Healthcare assessments and the introduction of "discharge to assess" processes during the pandemic. The experience of the first wave shows both were effective in removing bureaucratic barriers to getting people home safely.
The impact of COVID-19
COVID-19 shone a piercing spotlight on the vulnerabilities in a system beset by years of funding cuts, delayed reform and inequity. While trusts did everything they could to support the care sector locally by providing infection prevention and control training, personal protective equipment and staff to care homes, and discharging patients safely within national guidance, care homes and their staff and residents felt abandoned by the government. This must never happen again.
The COVID-19 response also highlighted the importance of delivering joined up care to meet people's needs in their own homes.
Co-Director of Development and Engagement
But the COVID-19 response also highlighted the importance of delivering joined up care to meet people's needs in their own homes. Community, primary and social care providers worked effectively together to support clinically vulnerable people including those shielding at home. Both NHS and social care providers want to lock in this improved integration and coordination across services.
The pandemic also exposed the inequalities that are deep rooted in society, and often reflected within our health and care system. Trust leaders are more motivated than ever to tackle this injustice alongside key partners. Government must play a key role here in placing social care on a sustainable footing to support the most vulnerable.
Government must act now to help the system weather this storm
We understand that government has been balancing a number of competing priorities over the last twelve months, prioritising an immediate response to the pandemic and seeking to balance protections for livelihood and liberties alongside safeguarding lives. However we must shift the political debate to seeing social care reform as central to our aspirations for a sustainable health and care system which works for local populations, moving forwards.
Given that the NHS long term plan was predicated on parallel political attention to reform social care, failure to do so, could risk the delivery of key commitments. It may also stymie progress made in integrated care systems to bring together health and care services to provide better joined up care for patients and service users. Without social care reform, we will see more avoidable pressure on NHS services, including growing emergency admissions and longer lengths of stay. The lack of social care capacity and workforce shortages will continue to slow down discharges and make future waves of COVID-19 all the more challenging.
In the 2020 spending review, the government rolled forward the non-recurrent £1bn social care grant for a second year but failed to take decisive action on a long-term sustainable funding settlement for social care. Government must address immediate gaps in local authority finances created by income losses during the pandemic. Government must work cross party to agree reforms which create fair pay and recognition for the social care workforce, improved access to publicly funded services, protection for individuals against care costs and the conditions to create a more stable provider market.
Reform is now long overdue and is more urgent than ever in the context of the COVID-19 pandemic.
Co-Director of Development and Engagement
Prior to COVID-19, the prime minister committed to "fix social care once and for all". Reform is now long overdue and is more urgent than ever in the context of the COVID-19 pandemic as the human cost of our failure to prioritise investment in care weighs heavily on our society. A "home first" model for people and their care should sit at the heart of this reform. The government must fix social care once and for all or risk breaking the NHS too.
This article was written for the Health for Care coalition, led by NHS Confederation, of which NHS Providers is a member.
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