The NHS and social care need to work together, too often vulnerable people are stuck between the two - Jayne Dowle
With the state pension triple lock under threat to fund Andy Burnham’s bold proposal of a national care service, it’s tempting to think that reform is all about the money and nothing else. Expect much tussling to come over this ‘triple lock’.
Introduced in 2010 by Conservative Chancellor George Osborne, its noble intention - to tackle pensioner poverty by increasing the state pension every year by whichever metric was highest - the rate of inflation, wage growth or 2.5 per cent - the cost of keeping it going has inevitably ballooned as the population ages.
According to the Office for Budget Responsibility, state pensions now account for more than half (55 per cent) of all welfare spending. By 2030, the triple lock will have added £15.5bn to the state pension bill compared with initial expectations.
Such billions could be spent on revolutionising the social care system, goes one argument. The counter-point of course is that pensioners, the demographic far more likely to need social care than any other, will be the ones to suffer financially.
Whilst Burnham’s plan for the national care system to be free at the point of entry could save individuals needing social care thousands and thousands of pounds, paying for it could hit their state pensions hard. And also, impact the state pensions of all the other older people who are fortunate enough not to need social care.
It’s a conundrum, isn’t it? And it’s very easy to think that the only factor holding back reform is the major matter of finding the money to pay for it. However, as anyone who has had experience of the social care system in England and Wales will know, for it to work effectively it cannot work in isolation.
Key is ensuring that the NHS and social care co-operate. Too often, a vulnerable or elderly person is stranded or shuttled between the two whilst different bodies argue over who is responsible for what.
My own 82-year-old father, who suffered a stroke in May this year, recently had a fall and spent 10 days in hospital. I saw first-hand how the NHS and social care quite often exist on entirely different planets.
The hospital and the stroke rehabilitation unit debated for three days who was responsible for carrying out dad’s ‘discharge to assess’, a process to determine the level of care he would need when he went home.
By Friday - the assessment still not done - it was too late to put his new care company in place, his NHS Early Supported Discharge care element having just ended. Dad spent another three days in hospital, blocking a bed, when he could have been at home. He finally went home on the Monday. His assessment was actually done in his own living room, the next day, raising some questions over the whole process.
Every day there are more than 13,000 people whose treatment has been completed but are still in hospitals in England, according to figures obtained by the BBC from NHS England in January. There are another 4,000 in the same predicament around the rest of the UK. This means around one in eight beds are occupied by people who don't necessarily need to be there.
Many of these "delayed discharge" patients are older, frail and need support when they leave hospital. All this comes at a cost. The average hospital bed takes £562 a day to staff and maintain, according to NHS England; the health service is losing more than £225m a month supporting patients who could be elsewhere.
A number of experienced voices, including York-based Matthew Taylor, former chief executive of the NHS Confederation, are arguing that the only credible way to ensure social care and the NHS have parity is to bring the two services together into one neighbourhood health and care system.
Whether an individual is in a residential care setting or receiving care at home, joint teams reduce “the risk of people being passed back and forth between organisations arguing over funding responsibility”, Taylor wrote in the Local Government Chronicle last year, a co-authored article with Jess McGregor, past president of the Association of Directors of Adult Social Services.
Their recommendations, including the importance of recognising social care workers “as equal partners, not the last stop in a pressured system” should be required reading for any government minister, and certainly for Baroness Louise Casey, who is leading Labour’s root and branch social care review.
Around the country - including here in Yorkshire - a number of localised initiatives are proving that it is possible for the NHS and social care to share resources, acting as one team at neighbourhood level.