There is a strong sense of déjà vu about Matt Hancock’s announcement last month of a White Paper proposing the greater integration of NHS and social care. A similar plan was put forward in April 2015 as the government’s ‘Better Together’ programme, with a pot of £5.3 billion to support it. The purpose of the programme then was to provide social care and support so that elderly patients could be moved out of hospital beds when their treatment had ended. Now that the Covid pandemic has highlighted the fragility of the social care system and its impact on the NHS, the thinking once again seems to be ‘Better Together’. Or will it fail because, as one national newspaper put it, there is a gap in funding so large it could be seen by a man on the moon looking through a foggy visor?
The Independent Care Group (ICG) warned that care providers looking after older and vulnerable people were in danger of again being left the poor relation to NHS care. Chairman Mike Padgham said that while it was welcome news that NHS reform is happening, ‘aside from mentioning social care, the government hasn’t gone fa enough in outlining its future. It’s vital that both are reformed at the same time, otherwise social care will be left behind once again. Reforming NHS care without reforming social care is like rebuilding a house with mending the roof.’
In 2015, the aim of Better Together was ‘to improve the lives of some of the most vulnerable people in our society, placing them at the centre of their care and support, and providing them with ‘wraparound’ fully integrated health and social care, resulting in an improved experience and better quality of life.’ The £5.3 billion Better Care Fund was not new money as such. Instead, it drew on existing streams that were ring fenced for this purpose. The pot was originally set at £3.8 billion, that included £3.3 billion from the core NHS budget with the rest from money set aside for carers and capital expenditure. It was topped up by extra funds that were put in by local areas that wanted to create bigger pooled budgets. Richard Humphries of the King’s Fund think tank said then that the fund was ‘not a substitute for the new funding needed to invest in essential changes to services’. And he was correct. Millions of older people are being refused social care as funding criteria has been is tightened because of lack of funding.
Last November The Carer UK magazine reported how the Health Ombudsman forced a local NHS CCG (Care Commissioning Group) to refund a son (Mr V) who had paid £250,000 for his mother’s care that should have been funded by the NHS’s Continuing Health Care. And former Rear Admiral Philip Mathias, once in charge of our nuclear deterrent, is has launched a Crowd Justice Fundraiser to fund the first stage of a judicial review to defeat this ‘scandal’.
Other countries with ageing populations have adopted an insurance type funding system, such as Japan. Last July, an article in the Guardian said that “The system that officials are considering is a modified version of how Japan and Germany fund social care.”
Sir Andrew Dilnot, who produced a plan for social care in 2011 which was not implemented said recently, ‘it’s all too easy for social care to slip back into the shadows once the most acute phase of the Covid crisis is over. We need to recognise that the social care system that we have at the moment, despite the wonderful work done by our carers is not adequate. It’s not something that we, as a nation, can be proud of, because we are not putting enough resources into it. We all need to make as much noise as we possibly can.’ (Daily Mail, Friday, Feb 12.)
Sir Andrew has commented that social care funding doesn’t get supported by MPS because they don’t hear from their constituents about it. ‘It’s not in their Inboxes,’ he said. Here’s where we can make a difference! Email, send a letter, or write to your MP. Write to your local newspaper. And pray.