Slow Train Coming
by Charu Agarwal, Senior Consultant

Last month, ninety MPs wrote to the Prime Minister calling for a cross-party review to address the challenges facing social care funding. Disquiet over the issue is not new: in August almost nine out of ten MPs, 86%, told ComRes (for Independent Age) that they saw a need for a cross-party consensus for a lasting settlement on health and social care. A Green Paper setting out the Government's long-term plans for care and support for older people is due to follow next summer.

Despite these efforts, a worrying chill fills the air as winter bites. Plummeting temperatures herald the inevitable NHS Winter Crisis and the corresponding surge in demand for health and care support, particularly for the most vulnerable.

The headlines last Christmas were dominated by record (high) A&E waiting times and stories of patients and staff hanging tough through the winter season; a situation health bosses will be keen to prevent happening again. But this is healthcare we're talking about, not social care: two different things, right? Well no, not entirely. Broadly speaking, social care refers to the day-to-day support that assists the vulnerable with living independently and playing a fuller role in society, while health care refers to the prevention, treatment and control of illness, injury, disease or disability. In the Barker Commission, the King's Fund explains how the two systems differ. While the NHS is (generally) free at the point of use and its resources ring-fenced, social care relies mostly on grants and council tax and its provision is rationed. The report goes on to posit a more integrated system as the future ideal. Indeed, to view health and care separately would be hastily short-sighted given an ageing population and rise in co-morbid illness. If we fail to consider that wider context, we overlook the obvious point that a well-supported society is also a better functioning, happier and more prosperous one.

Niall Dickson of the NHS Confederation, in a recent public statement, acknowledged the Chancellor's announcement of £335 million being put towards supporting the NHS with winter pressures, while pointing out Spreadsheet Phil’s steely silence on social care. The omission of social care from November's Budget was markedly odd, given the continued cuts to care providers in local authorities across the country, notwithstanding the '£2 billion over two years' injection promised back in March.

For some, the social care situation is chronically unsatisfactory. For instance, in Leonard Cheshire Disability's 2016 report The State of Social Care in Great Britain, ComRes found that half of disabled adults (48%) who needed social care support said they received none at all. While the NHS gets the cash, social care is in no less a state of emergency; even to the point of prompting ex-Prime Minister David Cameron to emerge from his shed on Saturday to highlight the “catastrophic” costs associated with dementia care, admit his administration failed to tackle the funding problem and call for its reform.

Until next summer’s Green Paper for the elderly is published and the direction of travel for social care more broadly is decided, our health and care services must brace themselves for heavy storms ahead. Without tackling the lack of investment in social care capacity, it is hard to see how the strains on the NHS can be relieved over anything other than the very short term. If Britain as a country can create long term investment strategies for policy needs such as pension provision, infrastructure and equalities, then we ought to be able to plan for the inevitable pressures on social care. Both current and future demographics (ie ageing) and lifestyle patterns (eg obesity rates) make it inevitable that people will suffer unless there is a long term strategy bringing health and social care properly together in a financially sustainable way.