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What’s Stopping Integration of Health and Social Care?

Health & social care is now part of the national conversation, yet we seem no closer to solving the NHS crisis. HPC Director Ian Wilkie considers why.

What’s Stopping Integration of Health and Social Care?

If there is any positive outcome from this winter’s NHS bed-blocking crisis, and the ongoing saga of inadequate care home provision in the UK, it is perhaps that these matters have been repeatedly brought to the public consciousness in recent times. That may not seem like much, but you only have to go back ten or fifteen years to a time when social care was simply not a subject the mainstream media was particularly interested in covering. Leaving aside for now the tendency of the press to follow the path of least resistance, or perhaps the most productive clickbait, in its “care home bashing” approach, this trend has at least brought social care into the national conversation. You may ask why this is important, when government appears to be no closer to solving these crises than it was ten years ago.

Anyone with even a passing interest in the Health and Social Care sectors knows two things; 1) the NHS is under huge pressure due to lack of available beds, many of which are “blocked” by elderly residents suffering from winter flu or other maladies (Delayed Transfer of Care (DToC)) and; 2) the care home sector is suffering under a burden of lack of funding. The CMA Report published in October 2017 made it clear that, on average, fees being paid by local authorities to care home operators fail to sustain levels of care required. A report published in January this year by Care Home Finder estimated there to be as many as 25,000 vacant care home beds available across the country.

On the face of it therefore, the solution seems simple. Move elderly people who are currently categorised as DToC out of NHS beds and into care homes, thus freeing up hospital beds and saving the care home sector in the process. Surely such a move would allow Jeremy Hunt, recently anointed Secretary of State for Health and Social Care, to theatrically dust off his hands, cry “job done”, and stroll off into the sunset.

That will not happen, however. It is estimated there may currently be around 6,000 DToC cases across the NHS. If those patients were to be moved overnight into care homes, the NHS beds they leave behind would not remain empty for long. They would most likely be filled almost immediately by patients currently on waiting lists, whose clinical diagnoses would require more expensive levels of care than those discharged ahead of them. So immediately, government funds have to deal not only with the 6,000 newly filled care home places, which may admittedly be cheaper on an individual basis than the hospital beds previously occupied, but also an additional 6,000 NHS beds, each of which may now cost double or more that of the previous occupant. In the end, it comes down to a simple matter of economics.

That is why the national conversation about social care has become so important. In reality, no government is going to solve this problem by kicking the can down the road or by publishing Green Papers. The only solution comes through more funding, and ring-fenced funding at that. It seems increasingly likely that some kind of national insurance scheme for social care will be the way to raise that funding. Such a policy has hardly been perceived as a vote winner by government or opposition in recent years, so the issue tends to get fudged in continued dialogue and political manoeuvring.

It just may be that the only time such a policy would be deemed acceptable would be if public clamour over social care reaches such a level as to alter the national mood, in a way which favours a vote for the party brave enough to propose such a solution. It is impossible to say which party that might be, or indeed if it will happen. However, if we are to see such a significant change introduced on the back of public opinion, perhaps we will have to see the crisis get worse before it gets better.

January 2018