Dr Ros Altmann
A report from the Health Select Committee highlights, yet again, the inadequacy of our health and social care system in dealing with the changing needs of our population.
The committee comments on the striking complacency of ministers, in the face of a crisis which is leaving so many older people with a poorer quality of life and without the care they really need.
Care Minister Paul Burstow denies that there is any shortfall in care funding
, insisting that by 2014/15 an extra £7.2bn will have been allocated to councils for social care. In addition, the minister assumes that 'efficiency gains' of 3.5% a year will, combined with the extra spending, mean there is enough money to cope with rising demands for care.
This astonishing statement flies in the face of all the evidence. First of all, the extra £2bn a year that is supposed to be given to local authorities is not ring-fenced for care, so councils are not spending it on care. Indeed, the report states that, in the past year, care spending has actually fallen by around £1bn, despite rising demand.
In addition, the committee says it is impossible to rely on achieving the assumed 3.5% efficiency savings, and if they do not happen the care system will remain inadequate.
For 40 years, UK governments have talked about 'integration', while the system has failed to deliver. Government has maintained separate silos for health (NHS), social care (local authorities) and housing (welfare), while trying to build bridges between each one to ensure they are linked up. This approach has failed time and again, yet the Government still seems to want to continue with this approach.
The committee is scathing of such policies. It points out that there are clear cases where proper integration of health
and care services have delivered demonstrable benefits to the quality of people's lives and saved significant sums to the NHS at the same time; for example, in Havering, east London, or in Torbay in Devon. Yet the minister apparently believes such examples are merely 'experiments that never got out of the lab'. Even worse, the current Health and Social Care Bill may even remove the Care Trusts that have been so successful in delivering integration.
This must not be allowed to happen. Torbay and other examples clearly show the benefits and cost savings of integrating NHS and social care and should be built on and rolled out elsewhere, rather than dismissed as laboratory experiments.
Having a single source to commission care is certainly sensible and long overdue. Relying on separate parts to join together by some trickle-down effect is not the most sensible way forward. As the committee says, we need a new strategy to cope with new realities.
With increasing numbers of older people needing different types of care from that provided just by the NHS, now is the time for change.
Our health service is wasting billions of pounds delivering the wrong type of care to our ageing population. Seventy per cent of hospital stays and more than 50% of GP appointments are for people with long-term chronic conditions that affect mostly older people. The reason many end up in hospital is because they did not receive the preventative treatment or social care that could have improved their lives without costing so much to the NHS.
The Health Service was designed with a different type of patient in mind. When most of the population are young, they need health services that treat 'episodes' of illness and then allow them to return to work. But with nearly 30% of the population at risk of chronic illness and increasing numbers of older people needing ongoing care management without acute medical intervention, we must rethink our whole approach.
Social care can save money and save lives, as well as improving living conditions for millions of people. The National Audit Office estimates that 30% of hospital admissions are avoidable and, if we get social care right, such savings can be delivered.
The forthcoming White Paper on social care is another chance to deliver on the promises of improvement and integration. We must not fail. The White Paper and Progress Report on funding will be an opportunity to show that the Government 'gets it' and can think longer term about how to improve social care funding, as well as helping individuals and their families prepare for future care needs in advance, rather than suddenly being faced with huge bills they have not realised they will face.
Andrew Dilnot's proposals on care funding offer a solid framework for future funding. A partnership between the state and the individual, with a capped cost model that helps people know what to expect. The Government needs to set out how it plans to introduce a cap and implement change.
Continuing to deny the existence of a care crisis is dangerous. It also risks bankrupting the NHS, as well as causing more misery to increasing numbers of older people and their families.