Do the words ‘social care’ make you feel bleak? In England, there has been a relentless drip of bad news about the state of social care provision: most recently evidence that hundreds of care workers leave jobs every week, making a workforce shortage worse, and compounding pressures on the mainly privately owned provider industry, that even the CQC described as being close to a ‘tipping point’.
It was probably the very visible impact of this funding crisis on the NHS – pressure on A&E departments, and delays in sending people home – that got through to government in the end. The spring budget unlocked an extra £2bn in the budget and, before the election was called a green paper on finding ‘sustainable’ funding options had been promised.
This extra money, welcome though it is, will not go far. Our own analysis of the social care funding gap and its impact on the local sustainability and transformation plans for health and care services (STP) showed that the gap for this year alone is likely to swallow up the £2bn, and be over £4bn by 2020/21. True, the extra money will reverse a declining trend and represent a growth rate of 2.3%, but as Ben Gershlick has calculated, we will barely be spending more than we did a decade ago on social care.
Policy makers tasked with the job of considering funding options for the green paper might be forgiven for feeling bleak about social care. One of the first problems they will have to get to grips with is the limitations of the data, particularly about the thousands of people who have fallen out of the publicly funded system in England, as Dr José-Luis Fernández at The London School of Economics and Political Science (LSE) explains. It is hard to see any solution that does not involve further increases in funding, particularly to support those who are least able to manage on their own. But the political appetite for raising taxes is likely to be limited, given the speed with which the government backed down over proposals to change National Insurance contributions.
Which brings us back to the other source of bleakness: how to persuade tax payers to invest in a service which is frequently portrayed in the media as poor quality, staffed by undervalued and low-paid workers, prone to lapses of neglect, a service which we may one day need, but none of us want to think about.
But our work at the Health Foundation suggests that improving the quality of social care is not a counsel of despair, even while a better long term solution is being developed. There are two resources already in place: the power of communities and the power of people working in social care settings, and both are being harnessed in a range of projects across the UK funded by the Health Foundation.
Altogether Better, a project in North Tyneside, is bringing volunteers into care homes, to work with residents, staff and other health and care professionals to enrich the lives of older people. The project’s director, Alyson McGregor, is inspired by the experience of her own father, who has dementia, and the joy that an activity like dancing can bring when all other memories have unravelled. And the joy lifts not just the older people, but the staff caring for them.
Unlocking the potential of people working in a generally undervalued service is at the heart of another project, known as PROSPER, based in Essex. A small scale project aimed at improving safety, which was funded by the Health Foundation, has been scaled up. What is striking is the hugely positive impact on staff, when encouraged to innovate and try out new ideas – including one project known as Pimp my zimmer. There is currently a real lack of improvement training on offer in the care home sector and no national or regional bodies ready to invest in this way in people working in care homes. This project shows what can be achieved when you do.
One of the other reasons for social care bleakness is the physical reality facing some of those needing care and the social care professionals who care for them. But innovation can be found here too: in North Cornwall, technology is being tried out to reduce pressure sores; in NHS Lanarkshire, staff are trying out new approaches to reduce and manage incontinence, promoting better health and reducing waste at the same time. New head mounted technology is being trialled in Eastbourne and Seaford Clinical Commissioning Group in Sussex to extend the reach of GPs, while barriers between social care and medical teams are being broken down and scaled up in Hampshire. We also know that better medical care in care homes is a proven way to reduce illness and hospital use
The great strength of social care, at its best, is the values that underlie it. A focus on mind as well as body, on quality of life, not just the presence or absence of a person in a hospital bed. Although recent experience may incline us to feel bleak about social care, it is these values which inspire hundreds of thousands of people to care every day, despite low pay. If these can be preserved, valued better across society, and built on, the future may be much brighter than we think.