It was good to see Rishi Sunak has pledged to reduce NHS waiting lists and ensure people get the care they need more quickly.
It is well-known that the lack of social care provision is part of the issue for releasing hospital throughput. Providers are unable to find staff and do not have the capacity to deliver the current volume of care required which enables patients to return home.
I have a five point response for Rishi Sunak & Steve Barclay:
1. Release the sponsorship licence constrictions for carers – we are so desperate none of us should have to pay. Make the Data and Barring service free – there are so many added costs we have to incur before a member of staff can join us. The demand is so high it’s necessary to release the barriers. I am not advocating we don’t do the checks, rather I am advocating making them easier for us to complete.
2. Stipulate that all Local Authorities pay providers in advance for the care they commission – we see providers struggling with cash flows, spending vast amounts with banks when it could be a simple accounting transaction with a monthly statement to account for credits and debits due. We spend a great deal of money on releasing cash to pay our carers what they need, when they need it.
3. Review the use of funds – I was part of a meeting with the DHSC where we were informed that £70m was to be allocated to training commissioners. This does not make sense. Surely an individual needs care, a provider provides care and you can use a map to see where your providers are and who best to provide to each individual!
Furthermore, according to an NHS source, there is now a plan to recruit an inclusion and diversity manager in certain hospitals – I question whether this is the most pressing use of NHS funds in the current climate. We need to get the money to the workforce on the frontline and consider technology to support efficiencies.
4. We need a social care secretary – health and social care, whilst intrinsically linked, need to both be developed independently to really resolve our challenges. The problem with having one role is that health care will always take priority & receive the funds first. We need funds for both. Spending on social care earlier in a vulnerable person’s journey can reduce NHS spend later down the line. Money spent on wellbeing, social prescribing and social care can help prevent vulnerable adults’ decline in health which is an ultimate saving on the health care budget. For example, prevention of falls, with some simple checks from a social care visit, can reduce hospitalisation for the elderly and therefore pressure on the hospital ambulance staff, A&E staff and finally hospital beds. If three of the key reasons for hospitalisation are isolation, poor nutrition and poor meds handling, improved social care is key to addressing these.
5. Social care is going to have to change the way it pays for care provision- currently paying for only the care call, leaves the carer vulnerable and out of pocket; they can be out for 12hrs but only receive 8hrs pay. Strategic commissioning will help this, but a 12hr shift in any other sector is paid as a 12hr shift – this is not the case with social care. You cannot always plan for short drive times and clients being close together because of the changes in your client base and the need to get people out of hospital. Local Authorities who have densely packed urban conurbations can keep their client base closely structured, but any rural communities will struggle and a carer should receive pay for every hour they are on the road. Local Authorities don’t currently factor in enough for this, they should be paying shifts.
In short we need the social care services to be in line with the government’s ambition. I had a requirement for a neighbour over the Christmas period – I phoned our local social services on the 30th December and finally got a call back on the 4th of January. This was an elderly lady in a crisis – how can that constitute an urgent response? The money given to help with winter pressures needs to be available for longer than March 2023, there needs to be a short, medium and long-term plan if we are to see significant changes. The NHS should sit outside the political arena; it is too precious. Every government must have the same commitment to the NHS, its standard of care and being fit for purpose. We used to have the best healthcare system in the world which I feel is sadly no longer the case, but with increased funding, good use of the money, and an injection into the workforce I can see a way forward. We are doing our part here at Abicare offering Care Hotels as a solution to support hospital throughput. These have carers 24/7 who offer full reablement services and provide community interaction and company for everyone who uses the service. They are a great example of a short-term, interim solution whilst we address the longer-term issues.