Roundtable: Social care and the A&E crisis

Q: Is the social care funding crisis piling pressure on A&E?

Cllr Izzi Seccombe, chair, Local Government Association Community Wellbeing Board

It is social care services that support elderly and vulnerable people to maintain their independence, live in their own community and stay out of hospital longer, which is why investing in social care is a crucial part in alleviating the pressures on the health service. Investing extra money in the NHS while forcing councils to cut their social care budgets is simply a false economy and will not solve this ever-growing problem.

The current care system is in crisis and unless adult social care is urgently put on a sustainable footing the situation is set to get even worse over next two years, and will undoubtedly continue to have a knock-on effect on vital NHS services. We simply cannot wait any longer for this to be fixed.

The combined pressures of insufficient funding, growing demand, escalating costs and a 40 per cent cut to local government budgets across this Parliament mean that despite councils' best efforts they are having to make tough decisions about the care services they can provide, potentially leaving the most vulnerable members of our communities at risk of losing essential care.

It's not enough to keep plastering over the cracks. Government needs to invest money in protecting a system which will be there to look after people in the future and not just in the immediate term. This will only be achieved through a determined effort from councils, the health service and Government working together.

We need a care system that is fit for the 21st century and it must be a shared ambition between councils and their health partners. If social care continues to be inadequately funded, this will tip some services into failure and leave the most vulnerable members of communities at risk of losing essential care.

Norman Lamb MP, minister of state for care and support 

Norman Lamb MPIn a bid to ease the pressure on the NHS during the current cold snap, the Department for Communities & Local Government and the Department of Health have released an extra £37m for councils to get people home from hospital more quickly and stop them from being admitted in the first place.

The Department for Communities & Local Government has provided £12m to help join up health and social care services so that there aren't delays for people who can be safely discharged and to avoid people needing to go to hospital in the first place.

The money will mean up to 3,500 more people a week will get home from hospital more quickly this winter, with the local authority putting in place carers and equipment to meet their needs, freeing up much-needed hospital beds within the NHS.

The extra cash is on top of the £700m the Department of Health has found for the NHS to help manage its winter pressures and a further £25m that councils have already been given [in January] to help speed up the discharge system.

It also comes ahead of the introduction in April 2015 of a £5.3bn Better Care Fund, which will start to transform the way the NHS and councils work together to put people first and enable them live at home with dignity and independence for longer.

This new funding means that every local authority now has extra money to help tackle the pressures on hospitals. We know the NHS is busier than ever before, which is why we've given a record £700m this winter for almost 800 more doctors, 4,700 more nurses and 6,400 more beds.

The NHS and local authorities are already preparing joint plans to work together better, keep people well and avoid hospital admissions. This new money will help speed up that work this winter.

Caroline Abrahams, charity director, Age UK

Caroline Abrahams, charity director, Age UK.Spending on social care services has fallen by £1.1bn since 2010-11.

The proportion of over-65s receiving any kind of support has fallen by 40 per cent since 2005-06 to 9.1 per cent. At the same time, the number of people in this age group has risen by 15.6 per cent to over 1.2m.

Since 2010-11, there has been a calamitous and quite rapid decline in services. The number of people receiving home care is down by 31.7 per cent to 370,630, while day care places have plummeted by 66.9 per cent to 59,125.

The more preventive services like meals on wheels and day care are being especially hard hit, leaving the system increasingly the preserve of older people in the most acute need, storing up big problems for the future.

Hundreds of thousands of older people who need social care are being left high and dry. The lucky ones have sufficient funds to buy in some support or can rely on the goodwill of family, neighbours and friends. But there are many who are being left to struggle on entirely alone. 

Until recently, the impact of the decline in social care has been relatively hidden but social care is a crucial pressure valve for the NHS and the evidence of what happens when it is too weak to fulfil that function is clear for us all to see.

Richard Humphries, assistant director of policy, the King's Fund

Richard Humphries, assistant director of policy, the King's Fund.Social care's role in recent A&E pressures is not straightforward. Attention has focused on the impact of social care cuts - both in rising numbers of delayed hospital discharges and more frail older people ending up in hospital because of lack of support. But there are 28 per cent fewer district nurses since 2009 and it is the combined impact of underinvestment in primary care and community health services alongside social care that demands scrutiny.

If the hospital is full, that is likely to mean that social care and community services are full as well. It is a two-way process: inadequate and poorly coordinated health care adds to the pressures on social care.

What should be done? Funding should focus on whole pathways of care, not just one-off bungs aimed at the most pressured part of the system. Protecting NHS but not social care budgets designs-in conflict. The Barker Commission made a strong case for a single ring-fenced budget covering both.

In the short term, a proper transformation fund, with new money, is needed to invest in better care at home services before hospital activity can be reduced. There is a bigger issue still about how we pay for the unavoidable costs of the success that an ageing population represents. The coming election offers an opportunity for a frank and honest dialogue with the public about funding options. As the Barker Commission argued, higher spending on care and health is sustainable and affordable, providing we face up to these hard choices and plan ahead.

Richard Hawkes, chair, the Care & Support Alliance 

Richard Hawkes, chair, the Care & Support Alliance.The Care & Support Alliance represents over 75 of Britain's leading charities. Every day, our organisations hear horror stories of people who struggle to get the support they need. This also has a huge impact on carers.

Chronic underfunding has seen a dramatic year-on-year rationing of support, excluding hundreds of thousands of older and disabled people from the support they desperately need.

Councils are in a tough position. Spending on social care has been prioritised but there isn't enough cash in the system for all those who need care to get it.

Research by LSE shows that 500,000 people who would have got care in 2009 are no longer entitled to it.

As a result, people become isolated, can't live on their own and slip into crisis, which inevitably has a knock-on effect on the health service.

Without adequate funding for care, the NHS will continue to be forced to pick up the pieces from a social care system that is not resourced to meet growing demands.

The Government needs to commit to serious investment in care, as well as in the health system. As experts argue, anything else is a false economy.

David Pearson, president, Association of Directors of Adult Social Services

David Pearson, ADASS.Has the penny dropped about the importance of social care? Adult social care is part of the solution and not, as so many have asserted over the years, part of the problem. In fact, courtesy of the Department of Health and DCLG, £37m worth of pennies have dropped. We all know that we need a sustainable approach to social care funding over the next few years but it does help with the ability of social care to respond to the increased need this winter, on the care of people outside hospital.

Indeed it makes good sense to protect health and invest in community provision and social care. Needs are rising; resources are reducing and, as the NAO affirmed,  there is unmet need. Directors of adult social services will need to focus on the need to prioritise what, after all, is only two per cent of public expenditure for those who need the support of us all the most.

The new money - and it really is new money - has to be spent by the end of this financial year, and will go some way towards:

- Helping to ensure seven day working across the country.

- Ensuring that assessments for making arrangements for care happen as quickly as possible.

- Ensuring that social work and other assessing staff plan more quickly for the support people need at home.

- Making more support at home available, such as home care and equipment to help remain at home safely.

- Funding the people who need a place in a residential or nursing home either on a temporary or permanent basis.

There is more to be done: crisis intervention needs to be enhanced; information should be shared more effectively; more supported living schemes such as extra care need to be developed; the voluntary sector more tightly involved and much, much more besides.

Yes, the penny is beginning to drop. But for the future we need a lot, lot more than pennies.

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