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Are we any nearer a political consensus on paying for social care

home-help-domiciliary-care

Since the seasonal break the media has once again turned its sights to what they perceive to be a health service that is at breaking point and A&E departments turning people away. The situation has become so grave that Joyce Robins, from Patient Concern, said: “I don’t think the NHS will be able to spin their way out of this crisis. The public deserves honesty about the state of the services on which they rely – I would simply not want to be in hospital right now.” Her comments come as the British Red Cross – which has been called in to prop up struggling services – described the overcrowding in Britain’s A&E units as a “humanitarian crisis”.

As long ago as January 2016 the boss of NHS England was arguing for a new political consensus on paying for elderly and social care, and the funding debate should consider the value of pensions and homes, the boss of the NHS has said.

Simon Stevens argued that one of the main questions in tackling the challenge of how to pay for and look after an ageing population was whether some of the money spent on increasing state pensions should instead be allocated for social care.

“What are the pros and cons of dedicating some of the proceeds of the triple lock to older people’s social care?” he asked. The triple lock promises to raise the state pension every year by the higher of inflation, the increase in average earnings or 2.5%.

Social care is funded by cash-strapped local councils, who have had their budgets cut by 40% over the past five years. It includes services such as help for people at home with basic tasks such as washing and eating as well as adjustments to homes to reduce the risk of a frail, elderly person falling, such as grab-rails.

NHS England’s chief executive feared the service would be unable to cope if the recent decline in help received by older people from social care services, especially in their own homes, continues to increase demand for medical care and problems of hospitals becoming overcrowded. He wanted the government at that time to rescue social care services from their downward spiral of funding cuts and increasing unmet need by reaching a political consensus on the payment for social care by 2018, to coincide with the NHS turning 70.

Some 12 months on it would seem that Stevens predictions are being realised, with further reports of an NHS in crisis. The new Conservative Government since coming to power have done little to seek a political consensus but rather choose to pass the buck to Local Authorities by allowing them to increase rates to provide more services.

In December 2016 Jane Cummings of Chief Nursing Officer NHS England said too much cash was being pumped into caring for patients in “old and expensive” hospitals, rather in a more efficient domiciliary setting.

In a letter to the Telegraph, Cummings said a greater emphasis on home care would result in a service that was better catered to a patient’s individual needs.

She said: “With more care provided at home, the NHS can spend more cash on patients rather than maintaining old and expensive buildings. And more people can be better looked after, with care personalised to their needs.”

She said refocusing the spending priorities towards domiciliary care would be controversial, but were necessary for the benefit of patients. In her letter, she said: “Whatever the merits of these plans, choices like these will always be controversial because we are talking about changes to strongly supported services that have served communities well for years.

“So this is not a moment to sit on our hands, nor to instigate big-bang changes. What we need is decisive but well-debated, locally owned improvements, doing things for which nurses, doctors and other health and care workers have argued for years.”

She said there was a real need to change “outdated models of care” so patients “don’t fall into the cracks between different parts of the system and ensuring that we provide care based around their needs, and not those of NHS organisations”.

It would seem then there a great deal of consensus that more care should be provided at home through domiciliary care agencies which would free up much needed hospital bed space and nursing time. This consensus however is not matched in the political arena, and we would seem to be light years away from gaining a political consensus and agreement to the payment for social care.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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