“Is the pandemic legacy a health and social care crisis from which we are on a road to nowhere?”
Originally published several months ago in Driven by Health. (Edited version Oct 22)
Whilst reflecting on the recent CQC state of report and Skills for Care Adult Social Care workforce that highlight the "grid locked" across our health and care systems, my "road to nowhere" article seemed worth of a revisit.
The National Media and Health and Care Sector Leaders have been sharing their concerns for more than 10 years that across our country's services are stretched to breaking point.
“The NHS remains in no position to reduce waiting lists or provide the high-quality service that patients expect. To make amends requires a cultural change at the heart of the NHS, whose main aim is caring for patients. To achieve this it must also take pains to care for the carers.” Myles Taylor Consultant obstetrician, Exeter (Times letters)
“Four in ten care homes can’t accept new residents. With now more than 10.7% vacancy rate across all social care posts we can truly see the impact of care workers turning their backs on the industry and heading for better paid jobs in supermarkets, the general retail sector and leisure and hospitality industries.
However, this should be a thriving labour market as Adult social care adds £51bn to the economy in England every year. By 2035 social care will also require an additional 480,000 posts to meet the population demand (27% growth), brining us to a total 2.27m workforce. Combined with the NHS workforce we are the UK's no.1 labour sector by size and economic status.
So where is the real problem?
It all leads back to chronic underfunding; Care worker median pay is £9.50 per hour. In the UK 80% of jobs pay more than this value. The money flows from central government to local councils and it is not enough for providers fund the "trust cost of care", by which I mean truly talented and wonderful people. More than 75% of social care costs are workforce pay.
Unison recently reported that Councils with social care responsibilities in England are facing a £2.1bn funding shortfall in this year 22/23, according to their research.
While NHS funding plans have been blown out of the water by the pandemic. In 2018 Teresa May’s settlement for the English NHS was to increase annual spending by an eventual £34 billion over five years, just two years into that plan the Department of Health and Social Care spent £63 billion on COVID-19 support in 20/21.
What we have to face now is the human cost that this is having on our communities. Most notably we can see enormous pressure upon Local Authority social care placement teams and Hospital brokerage staff to rapidly “unblock the cork” of patients waiting to be discharged into community care provision with no availability in many regions of either Voluntary sector or Independent care provision. This is not just impacting older people but all ages and conditions we offer care and support to in this country.
At Age UK Lancashire our Hospital After Care Service (HAS) is one example of how effective commissioning can increase flow rates through accelerated patient discharges processes and in turn reduce pressure on Social Care and the NHS services.
In December 2021 we engaged with Lancashire County Council regarding additional discharge capacity which required placing a member of our Age UK team alongside the ICAT (Integrated Care Assessment Team) teams across 5 Lancashire hospital locations. This in turn enabled more streamlined pathways for those being discharged from hospital ensuring the most appropriate service was made to people with complex needs across Lancashire. We also agreed to bolster capacity to support individuals discharged from Mental Health settings.
The outcome of this creative solution has been continuous support across our region of primary, secondary care, social care and ourselves working in a coordinated way to ease these consequences of staff shortages and overstretched systems.
However, this is not all about numbers it is about people such as Mrs S. admitted into the Royal Blackburn Hospital after enduring a fall at home while she was in the kitchen baking. We were rapidly able to asses her and deem that she could be taken home by our HAS services even though she was unsteady on her feet an required prompts to use her walking aids. Our initial assessment indicated that our team could offer short term support, with the likelihood of a longer-term care package being required.
We were able to ensure that the Home First Team could make the appropriate handrail adaptation Mrs S needed to climb the stairs and the Reablement team providing an additional ½ hour in the evening to the one hour provided in the morning. This has enabled Mrs S. to remain in her own home with the assistance of a minimal care package, most importantly home is where she wishes to live.
Mrs S. told us; “It is a pleasure to see Age UK each week, the lady is always ready to complete anything I need assistance with. I enjoyed her company, she doesn’t have a cup of tea, but we have plenty of laughs”
Overall what we offer is an alternative and integrated support to our health and care partners plus assistance to all people over 18 in our communities across Lancashire with the HAS service. This is one of many other examples I am sure can be found across our country where creative thinking, communication and effective commissioning can overcome this health and social care crisis.
I believe that, we are not on a road to nowhere, however we all have to jump on the bus and ensuring we leave our difference’s at the door, to ensure high quality care across our county and that we do not leave a lasting legacy of this pandemic and cost of living crisis on our Nation’s souls.