By Eleanor Mansfield
“Yeah, where is the geezer? I think he should be held account for it.” This iconic line was originally said by Danny Dyer referring to David Cameron’s role in Brexit. However, it also rings true for Cameron’s cuts to Social Care. Originally, funding fell by 10% for adult social care from 2010 to 2013, but this has now crept back up meaning the overall cut from 2010 is 5%. These may look like small figures, but the reality in provision of care is shocking with 400,000 fewer people receiving social care in 2013 than in 2009. Furthermore, the UK has an ageing population and we should be looking to increase social care funding not cut it.
Firstly, what is Social Care? Social care is practical support to those with illnesses or disabilities or for the people who care for them. It includes help at home from a paid carer
and the provision of care homes.
Social care is funded by local councils, not the NHS, and is means tested. This means that depending on your economic background you pay different amounts, with those with less savings paying less. The exception to council funding is Continuing Health Care (CHC) which is given to those with a ‘primary health need’ and is fully funded by the NHS. However, this an unbelievably complex system and there are huge discrepancies between different areas on how much they spend on CHC. This is an example of the bigger issue of social care, which is that funding is inefficient and unfair as different councils spend different amounts.
Well, what impact does this have on the NHS? The answer lies in the increased and prolonged hospital visits directly caused by the lack of Social Care. In a paper released by Efficiency Research Programme, it was found that in 2010, 23 out of 100 people aged over 65 visited A and E in that year. By 2015 this had increased by 4. This is partly because there are avoidable problems, such as dehydration caused by a urinary tract infection, happening because people are not receiving adequate care in their communities. It is also because more people are having to come in for conditions which could have potentially been treated out of hospital.
The lack of care home funding also means that some people are delayed from leaving hospital even though they are medically fit to do so. This is sometimes referred to as ‘bed blocking’ and is one of the most frustrating elements of NHS inefficiency. And it is not a small issue, in March 2018 there were 45,457 delayed days attributed to social care (out of 154,602). Delayed leaving is not only unpleasant for the patient but is also a drain on NHS resources especially when finding beds is a daily struggle.
Total DTOC (Delayed Transfer of Care) delayed days by quarter: '13/14 – '16/17
This is an issue which is only going to get worse. The UK has an ageing population, which means there is going to be an increased need for social care, and it is estimated that a funding gap for social care of £18 billion will have opened up by 2030. The state of the NHS in the last 10 years has already worsened, for example in November 2010, 97.3% of patients were seen within 4 hours in A+E whereas by November 2019 this value had fallen to 81.4%. A&E are waiting times are impacted by a vast amount of issues, but the lack of social care does contribute to them.
The government knows about these issues. There have been 12 green and white (parliament) papers in the last 20 years on social care but there has been no meaningful change. All that has happened is cuts (thanks Cameron) which are increasing the burden on the NHS. Social care is complex, it is expensive with no easy source of funding and it also struggles with staffing. However, for the NHS to survive the changing demographic of this country there must be an increase in funding for social (especially elderly) care otherwise the issues we have now will only get worse.
This article only scratched the surface of the issue of social care. It focuses on the relation between the lack of elderly social care and the short term consequences on the NHS. I have not mentioned social care for other groups such as the disabled, the ethics of Social care funding or the long term consequences (for example more chronic diseases) of an ageing population on the NHS, and why social care will play an increasingly important role. Social care suffers from a lack of understanding, partly due to people underestimating its importance and also because it’s an extremely complex system with many nuances. From my limited research I have realised that the role social care plays in this country is only going to increase. Because of this, I would highly recommend for anyone looking to work in the NHS to research it as it is going to become increasingly relevant.