Policymakers must appreciate the full breadth of care services and users if their plans are to stand the test of time
Fri 16 Oct 2020 08.20 BST
News of further delays to the government’s long-anticipated social care green paper was met with disappointment, if understanding, from councils, with England on the cusp of a second wave of coronavirus.
But the delay allows us to consider where reform could be heading, and the County Councils Network (CCN) has outlined the themes councils believe are integral to success: namely keeping social care a service overseen by local authorities, and for those working on reform to widen their focus beyond care for older people.
It has been suggested that ministers were considering centralising care, but this would be a flawed and kneejerk reaction to the devastation coronavirus has wrought on the sector.
Recent years have seen laudable attempts by ministers to bring social care on a more even footing with the NHS: from the rebranding of the Department of Health and Social Care to the recent health service-style “winter plan” for care.
For too long, social care has played second fiddle to the NHS, but these endeavours should not ultimately lead to the health service taking over commissioning from councils.
While the NHS works extremely well in treating people with acute health problems, usually for a short period in life, social care is care for the long-haul. It lets people live their lives as independently as possible, allows them to dip in and out of the system as needed, and provides them with round the clock residential care or comprehensive home care as their condition worsens.
If acute healthcare is a 100-metre sprint, then social care is a marathon.
For social care to work best, it needs to be embedded in the community. It is interwoven with a whole host of local authority services: from public health to links with community and voluntary groups, with councils having a direct role through personalised care plans or an indirect impact through managing local care markets.
During the height of the pandemic, these links and community expertise were invaluable. In North Yorkshire, the county council was able to offer tailored support to more than 1,000 individuals who receive bespoke care packages and in Somerset, 100 employees and councillors trained to be redeployed in social care roles.
Centralising care would remove these community links and hamper any reform that aims to provide a better system.
A starting point for reform should not to view the system as “health and social care” but as “acute” and “community” services.
After the harrowing scenes in care homes during the pandemic, it is understandable that the lens of reform will be focused on older people, but social care is much more than care for over-65s or hospital discharges.
A significant minority of those requiring care are working age adults with chronic conditions or disabilities: the CCN estimates costs for these individuals will rise by £861m in counties in the period 2015 to 2025.
A limited scope of reform would not take into account that care should play a strong preventative role in keeping people out of hospital for as long as possible, rather than a focus on discharging them into the community. In essence, social care should be seen as comprising of a larger breadth of services and users.
It is only when these key principles are embedded into the thinking of what care encompasses and how it should be viewed in relation to the NHS that there will be a strong foundation on which to answer the million-dollar question: how does the country fund adult social care?
CCN research has shown the extent to which the system is currently propped up by temporary or ad-hoc funding, and that is anything but sustainable in the long-term.
But more money will be no guarantee for a sustainable system, wrapped around the community and the individual, if the government has not put in place strong foundations with a changed perception of the health service and its relationship to social care.
Over the winter months, there will be an understandable focus on care homes and hospital discharges. But in the new year, policymakers need to widen their scope of the care system if reform is to stand the test of time.
David Fothergill is health and social care spokesperson for the County Councils Network and leader of Somerset county council