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Care services 'on verge of collapse'

Government urged to act as millions deprived of care and support

Mark Gould

Monday, 04 March 2019

A new coalition of 15 health organisations is warning that millions of vulnerable people are being deprived of the care and support they need because of the government’s failure to grasp the crisis in social care.

In a letter to the prime minister the Health for Care Coalition, which is being led by the NHS Confederation and whose members include the Royal College of GPs and the Royal College of Physicians (RCP), warns that services in parts of the country are near collapse.

In the letter they point to research from Age UK that estimates at least 1.4 million older people in England in need now receive no help because the social care system is failing. The letter comes in advance of the long-awaited publication of the government’s green paper which will outline options for how care and support services will be funded and provided to disabled adults and older people in England. The green paper has been delayed several times since it was announced in the March 2017 Budget, with the original publication expected in ‘summer 2017’.

Health for Care points out that it is unusual for one part of the public sector to argue for more funding for another part, but the NHS recognises its interdependence with social care when it comes to keeping people well and independent – as well as the particular role a fully funded, sustainable social care system can play in supporting individuals to live full lives.

The Health for Care coalition is calling on the government to create a sustainable social care system. It argues for a funding settlement, which puts social care on to a sustainable path for the longer-term, as well as addressing immediate needs from April 2020. According to the coalition, that will require secure funding commitments, a workforce strategy and a diverse and stable market of providers.

To inform the green paper, Health for Care has developed a set of principles to underpin a sustainable social care system, together with three recommendations to the prime minister that it believes are critical to achieving a long-term settlement:

  • Eligibility should be based on need and must be widened to make sure that those with unmet or under-met need have access to appropriate care and support.
  • Any new settlement should provide secure, long-term, funding at a level to enable the social care system to operate effectively and deliver the outcomes that people want and need, and,
  • Any significant additional funds must come with a willingness to reform and improve the ways in which care is delivered. Social care services and the NHS are working together to transform and integrate local care services, but they can only go so far when services are being placed under so much strain.

The coalition maintains that this is not only the right thing to do for some of the most vulnerable people in society but is also needed if the health service is to deliver the ambitions of the NHS Long-Term Plan. A lack of care and support packages in communities has led to thousands of patients being stuck in hospital when they no longer need to be there.

The work of Health for Care builds on analysis commissioned by the NHS Confederation from the Institute of Fiscal Studies and Health Foundation which found that social care funding would need to increase by 3.9% a year just to meet the needs of an ageing population and an increasing number of younger adults living with disabilities.

RCP clinical vice-president Professor David Oliver said: "Only by finding a sustainable solution to how we fund and provide social care can we ensure that our hospitals are able to cope with ever-increasing pressures. Finding alternatives to avoidable hospital admissions and delays to discharge will be good for patients and good for overstretched hospital doctors and their colleagues too."

And Niall Dickson, chief executive of the NHS Confederation, said: “Everyone’s mind is elsewhere just now, but this is a national scandal and a national disgrace. Record numbers of older people are being left to struggle each day without the care and support they need. It leads to a grossly inefficient system - the cost of doing nothing is great and the personal impact on individuals and their families can be devastating.

“Finding a sustainable solution is among the greatest challenges we face. Successive governments have failed to deal with this, but we have reached a point where we cannot go like this - time is running out.

“Our goal should be to deliver a settlement for social care in England that will last for generations. The promised green paper and autumn spending review present an essential opportunity to invest in social care over the longer-term, as the government is now investing in the NHS. Whatever proposals are included in the green paper, they must address the central issue of widening eligibility.”

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