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Misguided priorities and a lack of resources: why the Care Act is set to fail

Tuesday, February 17, 2015

The following was published by the Guardian

The number of people living longer is growing, as are the numbers of those who will need help and support in their eighties and nineties. There is also an increasing expectation that care will be provided at home, with fewer people needing to go into residential and nursing care. To accommodate these changes the government have been trumpeting last year’s Care Act as the way forward but on the ground the feeling is one of crisis.

Much of the hype about the Act focused on a new deal on residential and nursing home fees. But already only a minority of people go into care, and this proportion should decline further as better and more flexible care at home come on stream. Only those with very high needs and/or severe dementia are likely to need residential and nursing care.

What most of us want is better support and care at home. But reductions in budgets have led local authorities to concentrate solely on those in severe need. The knock on effect has meant the number of people receiving care at home has gone down from over a million to 850,000 in the last three years as a recent report by Age UK identified.

It is here that the Care Act falls short. The Government has introduced the Better Care Fund claiming it brings health and social care together for the first time. This is nonsense.

The NHS & Community Care Act 1991 had similar aspirations. It gave responsibility for assessing social care to local authorities with the idea they would develop community care services, and close co-operation between social services and health was vital. The local authority I worked in set up integrated health and social care teams who met weekly to assess and provide services. As a manager with a budget I could encourage and promote innovation that was driven by the needs of the local population.

In the intervening 20 years many authorities developed pooled budgets between health and social care and introduced new ways of working to ensure co-operation and integration. The Better Care Fund is but the same process mandated from government but, crucially, without any additional resources.

Encouraging greater co-operation is important, but not by top slicing the health service budget to pay for it. At a time of increasing pressures on the health service having its budget controlled this way means there is less money for other areas of its operations something has to give.

The Care Act is set to fail. It sets eligibility criteria for support and the accompanying guidance makes it clear local authorities can limit this to high level needs only. Inevitably most of them will go along with this and only provide high need services.

Yet many people in the greatest need receive such care and support from families and friends. If they are receiving that care from a family then the local authority do not have to provide any additional help. The kind of tasks include dressing and basic personal hygiene. It is therefore not surprising that many people would prefer a relative or friend to help them.

The problem however is that when the need for this care goes on a long time, carers get tired and ill and the situation can deteriorate quickly. By providing some low level support such as cleaning or shopping, or occasional sitting services, many family carers would be able to continue.

The Labour proposal is to properly integrate health and social care to create a national care service mirroring the National Health Service. It is hard to see how this would significantly change the rationing of care services leading again only to the highest needs being met.

An alternative view

A simple change is needed: when a person is assessed as being in high need, local authorities should provide appropriate support and not be limited in the choice of services. We need to recognise that low level services provided to vulnerable people can make a huge difference and don’t cost much.

Similarly basic services such as cleaning and shopping make a crucial difference to a carer who may be looking after someone 24 hours a day. They enable them to stay healthy and keep going. A carer who has to stop caring is a significant reason why many people end up in hospital or residential care.

An innovative project in Sheffield is already demonstrating how this might happen. Started as a pilot scheme in one area of the city, the "Keeping People Well" project has received 1 million funding from the Department for Communities and Local Government to provide services across the city.

At its heart are community support workers who visit vulnerable people and put them in touch with local services that will support them. The aim is always to achieve better help within the community by existing organisations which aren’t limited to public services, it could be a local shop, church or hairdresser. The value of low level help and support is recognised - from sitting services, through befriending, shopping and pet care.

The city council has also recruited 150 volunteers from amongst its staff who are ready to be asked to provide the occasional helping hand. In the recent snowy weather people at risk got phone calls to check they were safe, if they wanted some shopping done, or perhaps a friendly face at the door making sure they were OK.

A community support worker will soon be based in A & E who will bring the same level of knowledge of local services and be able to help someone to go home, avoiding unnecessary admissions to hospital. Lorraine Jubb, who leads the programme, wants to focus on a small range of services easily provided rather than a system that has become overburdened with assessments.

I am attracted by the straight forward approach, and the understanding that being lonely and not being able to get some cleaning done are important in maintaining older people at home. Diverting funds to real community care, supporting informal and family carers has got to be both desirable and a better used of hard pressed resources.   



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