Government failing on social care and health inequalities

By Kari Gerstheimer

The government’s failure to reform social care funding in the Health and Care Act is compounding regional health inequalities, writes Kari Gerstheimer, CEO and Founder of Access Social Care.

Speaking before a Cabinet meeting last month Boris Johnson stated that: “With household bills and living costs rising in the face of global challenges, easing the burden on the British people and growing our economy must be a team effort across Cabinet.” He added that “we will continue to do all we can to support people without letting Government spending and debt spiral, whilst continuing to help Brits to find good jobs and earn more, no matter where they live.”

However, the Prime Minister’s own assurances on protecting the British public from rising costs were set against the Government’s actions regarding the Health and Care Act, which has just been enshrined in law.

The Prime Minister continues to make promises to help the British people with the growing cost burden, while the Health and Care Act leaves those on the lowest income exposed to spending a greater proportion of their assets on care costs, during the worst financial crisis we have seen in generations.

The Government’s own amendment to the Bill, which was subject to a fierce debate in both chambers of Parliament before ultimately being voted through, means that the local authority support people receive to help them meet their care costs, will no longer count towards the proposed £86,000 cap.

This is all the while that the PM has continued to make promises to address the decades-long social care funding crisis and widening health inequalities. The £5 billion in extra money announced for social care over the next 3 years, is of course welcome. But there is no mathematical link between the amount of money and the level of need. The Health Foundation calculates that at least £8 billion are needed per year, just to deliver what councils are legally obliged to.

Failure on “levelling-up”

Research commissioned by Access Social Care, which provides free legal advice for those with care needs, shows that poorer areas with lower council tax and business rate yields have been worse affected by the reduction in the central Government grant for social care.

This means that people living in poorer areas where social care need is often the greatest, are already getting a bad deal compared to other parts of the country, which flies in the face of the much-vaunted concept of “levelling-up.”

Rather than addressing this unfairness, the Government’s amendment is compounding it, by leaving people living in ‘red wall’ areas having to spend a greater percentage of their total assets on care.

The Health and Care Act is a clear contradiction in the PM’s assurance to focus efforts on easing the burden for British people and protecting the public from rising costs. It will instead deepen the cost of living to the poorest of our society and widen long-standing health inequalities.

Access Social Care are already seeing cases where the cost of living crisis means that people cannot afford the social care they so desperately need. The Government urgently needs to do more to ensure that everyone can get the social care they need, at a price they can afford.

The UK must harness data and digital to revamp stroke aftercare – Mike Farrar

By Mike Farrar

Stroke is the single largest cause of complex disability and long-term thinking around stroke aftercare is critical in easing pressure on health and social care.

The NHS Long Term Plan places stroke aftercare as a key priority area for improvement. However, ongoing data shows that the promises to ensure the best performance in Europe for delivering clot-busting thrombolysis by 2025 and increasing the number of patients receiving reviews of their recovery needs (from 29 per cent to 90 per cent), is unlikely to be met.

The stroke pathway has seen significant improvements over the last decade. These include the introduction of hyperacute stroke units, improved brain-imaging, rapid thrombolysis and game-changing thrombectomy. However, it is likely that these interventions will be undermined by the failure to recognise the opportunities to help people return to productive lives after a stroke.

Stroke care is an area that has seen substantial improvement in the UK; while mortality rates have halved over the last 20 years, stroke remains the single largest cause of complex disability. Further to this, recent research from the Stroke Association five-year survival rates remains low.

The Stroke Association estimates that 100,000 people have a stroke in the UK every year, with two thirds of survivors leaving hospital with a disability. There are currently 1.2 million stroke survivors living in the UK, at an estimated cost to the health and care sector of £26 billion a year. This cost is expected to triple by 2035.

Missing parts of the stroke pathway

The provision of rehabilitation and aftercare is an essential element of the care pathway yet is often the least well supported and resourced, a situation not solely limited to stroke care.

This is not unique to the UK and clinicians in the USA are experiencing similar issues. Once a patient has left an acute situation, where the latest interventions, medications and technological advancements have been provided, the same level of attention just isn’t there post-discharge. There is often a marked deterioration in wellbeing with an undetermined longer-term impact.

Stroke aftercare: a faulty mindset

There is an underlying mindset within the system that the priority lies with acute care management and what happens after is less important. As a system, crisis response is generally exceptional, and innovation and resources tend to be focused on this stage of patient’s journey. But there is very little strategy – and the funding treadmill is perpetuated by continually focusing investment on acute interventions. But it is clear that the cost benefit is poor if a more strategic view of the whole care pathway is not taken.

The failure to provide effective rehabilitation immediately after an acute episode can lead to reduced functioning mobility and normal life for the individual. The consequence of this failure is an added cost for the health and care system, reduced economic productivity and can increase social care costs if it leads to patients losing their ability to live independently.

Masking the real data

The data currently collected typically identifies re-admitted patient episodes as a new case rather than allowing the system to recognise and then count it as a re-admission. This often masks the failure of the rehabilitation and ongoing support offered, which could have prevented further problems.

The link to co-morbidities is also missing, with more people dying in the first six months after a stroke from cardiac events, rather than consequences of a stroke – which means we are overlooking opportunities to influence outcomes in other ways.

The cost of high-quality rehabilitation may pay itself back over time but immediate cost pressures in the system can often mean that rehabilitation is not funded as a priority, in turn reducing patient outcomes.

Balancing the funding model

So, what should the path forward be from here? The key to achieving the right balance is to argue the need for a greater use of data and to provide the evidence to build up the business case. There are some professionals and clinicians leading the charge and looking for that evidence to balance the funding model.

The Mount Sinai health system in the USA recruited a randomly selected sample of people who were enrolled in a remote monitoring programme. Of the sample, 90 per cent of the sample had a crisis that the health system could have intervened on. Without the follow-up, these crises would never have been caught.

In Cardiff and Vale in Wales, they’re currently trialling a system that joins up the data to the patient – rather than the episode – to track the re-admissions and the patient’s entire journey through the health system. The data outcomes are providing interesting insights into chronic conditions and helping to modify care providers’ understanding of where they put their money.

The role of data and digital in stroke aftercare

There is also seeing a role for digital platforms to be used for virtual rehabilitation. There are many ways to do this and the growth of digital care technology in local authorities should be used to support and endorse these changes across the whole health and care system. As an example, Visionable’s platform allows any deterioration in health to be identified early to prevent serious problems occurring, including readmissions. As people wait longer for care, this early warning is crucial to avoid patient harm.

There’s a real opportunity to shift the way rehabilitation pathways are approached, and how outcomes are tracked. This dialogue should really appeal to the new integrated care systems and their integrated care boards as the NHS embark upon seismic structural shifts in 2022.

Through system-wide commissioning, there is the opportunity to balance the investment and provide transformation – and to deliver a genuine whole pathway, including more robust rehabilitation services. Enhancing data capture in real-time and making sure the money follows the patient could produce marked differences – not only for the public purse, but in the quality of people’s lives.

Royal College of Physicians issues stark warning over social care crisis

By Gabriel Blaazer

The Royal College of Physicians is warning that the combination of an ageing population and a lack of NHS workforce planning means the country is risking an unavoidable crisis in social care for older people.

The Royal College of Physicians (RCP) has issued a stark warning that NHS workforce shortages are driving the social care crisis in England and that the NHS is “woefully unprepared to cope with an ageing population.”

New analysis from the RCP shows that there is the equivalent of just one full time geriatrician per 8,031 people over the age of 65 in England. The findings use data from the RCP’s own census of physicians and the Office for National Statistics’ (ONS) population data and demonstrate the extent to which England’s care crisis is only set to grow.

The ONS estimates there will be more than 17 million people aged 65 and above in the UK by 2040, meaning 24 per cent of the population would require geriatric care. Additionally, many of the doctors currently providing geriatric care will, themselves, soon be requiring the same care, and 48 per cent of consultant geriatrics are set to retire within the next 10 years.

Considering these trends, the RCP, along with more than 100 medical organisations, is supporting an amendment to the Health and Social Care Bill requiring the government to publish “regular, independent assessments of the numbers of staff the NHS and social care system need now and in future.” No such data is currently publicly available. The amendment, currently being debated in the House of Lords, was tabled by Baroness Cumberlege and is supported by former NHS England Chief Executive Simon Stevens (now Lord Stevens of Birmingham), is set to be debated in the House of Lords

Responding to the RCP’s warning, Danny Mortimer, Chief Executive of NHS Employers and Deputy Chief Executive of the NHS Confederation, said: “As exhausted NHS staff strive to tackle the enormous treatment backlogs that have resulted from the pandemic, we must not forget about the pressures that our health and social care services face as they work to meet the growing needs of our ageing population.

“To be able to plan effectively for a future workforce, healthcare leaders need clarity in the shape of a clear long-term workforce plan. Sajid Javid’s recent commissioning of a workforce strategy is a very welcome step, but… we would urge the government to accept amendments requiring the health secretary to publish regular, independent assessments of the numbers of staff the NHS and social care system need now and in future.”

The President of the RCP, Andrew Goddard, said: ““I have dedicated my career to working in the NHS – a service that I am fiercely proud of – and yet it scares me to wonder what might happen should I need care as I get older. There simply aren’t enough doctors to go round, not least within geriatrics.

“The workforce crisis we’re facing is largely down to an astonishing lack of planning. All successful organisations rely on long-term workforce planning to meet demand and it’s absurd that we don’t do this for the NHS and social care system. The government needs to accept the amendment put forward by Baroness Cumberlege and make workforce planning a priority.”

Dr Jennifer Burns, President of the British Geriatrics Society, said: “These figures show very clearly the current nationwide shortage of geriatricians – a situation that will only get worse with the predictable rise in the numbers of older people across the UK needing healthcare.

“It is absolutely vital that these fundamental issues around the recruitment, retention, development and support of the workforce are addressed, and that there is a properly-resourced strategy for future needs. The British Geriatrics Society stands with the RCP in strongly supporting the amendment to the Health and Care Bill.”

New white paper seeks to clarify what integration means for patients

By David Duffy

The government has published its eagerly awaited Integration white paper, designed to clarify exactly how integrated services will improve care for patients and end users across England.

The paper outlines a series of priorities for integrated care systems to improve health and care delivery. These include enhancing transparency and choice of care increasing earlier intervention of care, as well as increasing flexibility and developing clearer communications between different service providers and enhancing overall value for the taxpayer.

Commenting on the paper, Prime Minister Boris Johnson said: “These plans will ensure no patient falls between the gap [between services], and that everyone receives the right care in the right place at the right time.”

This sentiment was echoed by Health and Care Secretary Sajid Javid, who said: “Our Integration white paper is part of our wider plans to reform and recover the health and social care system, ensuring everyone gets the treatment and care they need, when and where they need it.”

The Integration white paper follows a day after the NHS published its Elective Care Recovery Plan, outlining how the health service intends to bring down ominous backlog figures and repair waiting times following Covid-19 disruption to services.

Proposals outlined in the recovery plan include a focus on community diagnostics and new approaches to care that will only be possible to deliver through integrated care systems (ICSs). This new white paper seeks to outline how health and care systems will draw on the resources and skills from across NHS and local government to “better meet the needs of communities, reduce wating lists and help level up healthcare across the country”.

Also commenting on the Integration white paper, Mathew Taylor, Chief Executive of the NHS Confederation said: “As these proposals are developed further, it is important that we recognise the differences that exist in local areas including in local relationships. They will need to evolve in their own way if we are to crack this agenda.

“Finally, for integration to work there needs to be joined up thinking across government as well as at local level. Ensuring this will allow local leaders the freedom to work with their communities to identify what will provide the best outcomes for the public.”

Hugh Alderwick, Head of Policy at the Health Foundation, highlighted the importance for adequate funding if these system reforms are to be possible: “Better integration between services is no replacement for properly funding them. The social care system in England is on its knees and central government funding over the coming years is barely enough to meet growing demand for care – let alone expand and improve the system.

“More integration is also little good if there aren’t enough staff to deliver services. Staffing shortages in health and social care are chronic, yet government has no long-term plan to address them.”

Analysis

For those who have been close to the integrated care agenda in recent years, or indeed attended virtually any event around integration, there will be little new insight within this white paper – nor will there be much to disagree with. Health and care integration is not a new concept, and so the broad concepts within the government’s latest paper come with little in the way of new proposals. The paper is more of a clarification on what integrated care seeks to achieve rather than an explanation as to how it will be delivered (the absence of additional funding proposals and clear strategy to address workforce shortages is telling).

Not that the document isn’t useful, public perception and understanding of integrated care is still very poor. Delivering integrated care in practice will be difficult unless this understanding is improved and, to this end, the white paper provides some useful clarifications.

But the timing of the paper is as important as its contents. Building on the recent publication of the Levelling Up white paper and published a day after the NHS elective care recovery plan, the Integration white paper is an attempt to show that the government are looking beyond the acute sector and are serious about “Levelling Up”.

The white paper also comes as the Prime Minister is desperately trying to build some policy momentum and move away from what has been a disastrous period for his premiership. Time will tell whether this series of flagship policy proposals (which will precede a further paper outlining specific plans to address health disparity) will provide the antidote to the partygate scandal.

Key priorities of the white paper:

Better transparency
More personalised care
Earlier intervention
Clear communication
Improved access to social care services through NHS data sharing
Better treatment
Better NHS support to care homes
Coordinated services
More flexible services
Better value for money

NCF to help care providers navigate integration

By Integrated Care Journal

The National Care Forum (NCF), the membership organisation for not-for-profit organisations in the care and support sector, has created a range of dedicated resources and information to help social care providers understand, navigate, and improve the integration between health and social care as they prepare for the integrated care systems (ICSs) to go-live on 1 July 2022.

Having now been passed into law, ICSs will be given a statutory underpinning across England as the Health and Care Bill. This partnership model brings together providers and commissioners of NHS services across a specific geographical area with local authorities and other local partners, such as social care and housing, to collectively plan health and care services.

It is a fundamental shift in the way the health and social care system is organised in England – moving away from competition and organisation autonomy to collaboration between health and care organisations to integrate services, reduce health inequalities and improve population health and wellbeing.

The new resources launched by the NCF include:

Definitive, dedicated ICS training: What the social care provider sector can do for the ICS

NCF have partnered with the Housing Associations’ Charitable Trust (HACT) to bring together a dedicated learning and development programme during June and July to support the sector in working with ICSs. The programme aims to enable delegates to engage in long-term partnerships that transform the delivery of health and care, while simultaneously resulting in better integration between social care provider organisations and health. The training will help social care providers:

Understand more about ICSs
Strengthen their understanding of how to engage with their local ICS
Build awareness of the competencies needed to deliver within integrated care settings
Identify partnering opportunities and build credibility

A dedicated and facilitated discussion with NHSEI/DHSC and social care providers as part of a listening exercise on Monday 9th May to understand the challenges and successes of engaging with ICSs. The session will aim to achieve agreement to coproduce a model for engagement with the social care provider sector and to think about where efforts would be most effectively focused. This builds on the collaboration between NCF, NHSEI and DHSC over the last few months to support ICS engagement with the social care sector.

An online ‘one stop shop’ on the NCF website that offers a simple overview to ICSs, interactive maps to find out which ICSs operate in any area, key messages to help ICSs understand how social care is central to improving health and care for their local populations and case studies to showcase how engagement can work on the ground to make a difference for people using health and care services.

Vic Rayner OBE, CEO of the National Care Forum said that “the introduction of integrated care systems is a major change to the health and social care system in England and as such it is imperative that the social care sector fully understands and engages with the process of transition to this new model of partnership working.

“We have created these resources to support our colleagues from across the sector to strengthen their understanding, upskill their competencies and build their confidence in identifying partnering opportunities that integrate health and care services while improving peoples’ health and wellbeing.”

If you would like to find out more about the resources available on integrated care systems or to attend the training sessions, please visit the NCF website.

Change to Health and Care Bill: Costly consequences for poorer regions

By Niamh Macdonald

MPs in Yorkshire, the Midlands and the North East should vote down the government’s social care cap amendment to save their poorer constituents from ‘crippling care costs’, warn the Health Foundation and the King’s Fund.

The Health and Care Bill, due to reach final stages in the House of Commons on 25 April, includes an amendment from the government which would mean its social care reforms would offer less protection to poorer people.

According to the Health Foundation and the King’s Fund, people in Yorkshire, the Midlands and North East of England would feel the greatest impact on their protection against high care costs due to the amendment.

In 2021, the government proposed a cap of £86,000 on the lifetime care costs that an individual will have to pay for personal care. However, it also proposed amending the 2014 Care Act to mean that local authority support given to help meet an individual’s care costs would no longer count towards the cap.

This amendment will significantly reduce the benefits of the reforms for people with lower levels of wealth but those with housing wealth of more than £186,000 will be unaffected.

Irrespective of wealth and assets, the amendment will mean everyone will face the same costs. The effects of this are far more severe for those with low to moderate assets, meaning some may be forced to sell their home to finance their care.

A joint Institute for Fiscal Studies (IFS) and Health Foundation report, funded by the Health Foundation, recently assessed the impact of the government’s amendment. It analysed how the amendment would affect people in different regions of the country.

The report found that for people spending ten years in residential care:

People in the North East would spend on average an extra six per cent of their assets on care. This is equivalent to an average increase in contribution of £5,700.
In Yorkshire and Humber people would spend an extra five per cent of their assets, equivalent to £5,300.
In the Midlands it would see an increase in payments worth four per cent of assets, equivalent to £4,600.
These increases compare to two per cent in the South East and one per cent in London, equivalent to £3,800 and £2,800 respectively.

Charles Tallack, Director of Data Analytics at the Health Foundation, said: “The government’s amendment represents a significant watering down of the pledge to protect people from catastrophic care costs.

“At a time when the country is facing the biggest hit to household finances since the 1950s, government should be looking to increase financial protection for poorer households.

“Yet this measure will disproportionally affect people with lower wealth and in poorer areas of the country. This is not levelling up: it’s unfair and a backwards step.”

Sally Warren, Director of Policy at The King’s Fund, said: “The government’s change to the cap on social care costs is expected to save the Treasury money, but that saving comes at the expense of poorer people with lower levels of wealth and assets.

“Many of those people will be wondering why the Prime Minister’s pledge that no one will have to sell their home to pay for their care no longer applies to them, whilst wealthier people are still protected from catastrophic care costs.”

Care employers come together for Ukraine

By Integrated Care Journal

With the conflict in Ukraine raging, care employers are working together to provide opportunities for those displaced to work and find a home in the UK.

Care employers have been working together to understand how they can provide a meaningful employment opportunity for those displaced from Ukraine and other parts of the world and finding a home within the UK.

The National Care Forum (NCF), the leading association of not-for-profit care and support providers, in association with the Care Provider Alliance, have brought together a wide range of partners committed to offering support. This includes expertise from across national and local government, housing, recruitment specialists, legal and immigration experts and regulators.

Employers and partners are working closely with recruitment experts to enable displaced people from Ukraine and other parts of the globe to identify roles within the care sector, direct individuals to localised support and ensure that employers work together to provide the best opportunity for those who wish to work.

While this work progresses, the broader support for people displaced from Ukraine through the Homes for Ukrainians scheme is being clarified. Alongside this, local government has an important role in regards to how local support will work, and specific roles and responsibilities are still emerging. It is imperative that the desire to work is aligned with the need for displaced people to be connected into wider community and pastoral support.

Vic Rayner OBE, CEO of the NCF said: “Like many people affected by the plight of the people of Ukraine, care employers are pulling together to take action to help. The ideas are progressing at pace, and there is a strong desire to do something meaningful to help the people of Ukraine, and others from around the globe who arrive into the UK.

“We are pulling together opportunities for care and support employers to share details of available job vacancies, which we hope will be tied into the broader communications for displaced people. There are many other ways for people to offer support, including support to Ukrainians needing care and support, assistance with vetting and matching, and those who have a housing solution.

“However, there remain significant unanswered questions around regulatory requirements, right to work entitlement, safeguarding, etc. We need the government to work at pace alongside adult social care employers to resolve this. Furthermore, we are working with other partners, to understand how most effectively the sector can be engaged to provide a solution at this moment of crisis.”

News, Partners, Population Health, Social Care, Thought Leadership, Workforce April 4, 2022

More support needed for “fatigued” social care workforce

By Mary Brown

On the 16th March 2022, Public Policy Projects (PPP) hosted an evidence session entitled The Social Care Workforce: Averting a Crisis as part of its report series The Future of Social Care. PPP’s Social Care Network examines the most urgent issues facing social care and presents tangible solutions to address workforce challenges in the sector.

The crisis facing the social care sector is fundamentally a workforce one. The sector itself is a large employer in the UK, employing about 1.54 million people, equivalent to five per cent of the workforce. As one participant noted, “the sector itself is a huge contributor to the economy and to society”. Given that staff pay is the single biggest expenditure faced by care homes, workforce management should be front and centre whenever system finances are being considered.

Even before the pandemic, there were about 112,000 social care vacancies in England, with jobs paying only £8.50 an hour. Following the pandemic, the vacancy figures are assumed to be worse. Key issues driving individuals away from working in the social care sector include low pay, stressful working conditions and a low sense of worth.

A participant of the evidence session emphasised that the working conditions of the social care sector have led to 74 per cent of care professionals reporting that they regularly experience stress at work, an average number of sick days 25 per cent above the national average, and a staff turnover rate significantly higher than the national average.

As phrased by one participant, social care is suffering from a “fatigued workforce” not only due to the pressures of the pandemic, but issues which have existed within the sector for much longer. The problems within the social care workforce are chronic , and are considered by many to constitute a crisis. As one participant said, “clearly a workforce strategy is one of the absolute essentials that we need to have to make a success of the sector over the next decade or so”.

“The social care sector should work alongside recruitment organisations to recruit young, bright people into social care, and help them consider where a career may lead.”

One problem identified was narrow recruitment to the sector. It was stressed that within social care, “we should cast our nets wider in a recruitment approach… and recruit not only people with previous experience”. The social care sector should work alongside recruitment organisations to recruit young, bright people into social care, and help them consider where a career may lead.

It was also suggested that more effort must be made to recruit hard-to-reach and underemployed groups, including people living with disabilities, and immigrant workers. “What frustrates me is that there are individuals in these groups who can be wonderful, caring staff [but]are missed, because hiring managers are too narrow in their focus”, said one participant.

Staff retention rates in social care are low. Network members noted that social care workers often leave the sector for other, similarly paid jobs, such as retail roles, while few choose to leave and work for the NHS. One network member identified that “between care assistants in the NHS and the social care sector, there is around a 23 per cent deficit in social care. The terms and conditions are vastly better in the NHS. Pensions, sick pay, overtime and unsocial hours all contribute to that deficit.”

Essentially, social care workers are underpaid and undervalued. For both better recruitment and retention, social care workers must be appropriately paid and treated as though they are valued. Some network members identified low pay as the key driver for individuals choosing to leave the social care workforce, and yet, it was emphasised that social care is a both a skilled and psychologically demanding profession, and should be commensurately well-paid.

However, funding in the system is limited, and paying the workforce is the sector’s single biggest expense. One participant said “there is not a settlement from government or local government that actually meets the cost of care to enable us to pay a proper wage for the level of skill, ability, responsibility, dedication that [care workers] have”. Furthermore, a high proportion of social care workers are on zero-hours contracts; in London, this figure stands at 41 per cent of social care workers. Therefore, many social care workers have to deal with pay inconsistency and insecurity, on top of being low-paid.

“Network members were in agreement that social care is, and should be publicly regarded as, a skilled profession.”

While pay is regularly described as the most pressing issue in the workforce, one participant argued that in their experience of conducting exit interviews with workers, it is not low pay, but rather a low sense of worth which leads people to leave the profession. While higher pay is one way in which care workers can be practically appreciated, it was agreed that more must be done to value care work both by improving the public image of care workers and ensuring that internal structures provide support and give value to workers.

Network members were in agreement that social care is, and should be publicly regarded as, a skilled profession. “It is not the kind of job that everyone can do,” said one participant. “It is a skilled job, which requires the creation of quality human relationships and working with people who have complex care needs… it is a real skill and should be regarded as the same as working in health.”

Social work is challenging and worthy of respect, all participants agreed. One commented that “no two days in social care will be the same; you have to be agile and move with that, so it does take very special people to take those roles”. The public status of social care work must be elevated to reflect this, and the workforce to feel appropriately valued if these retention issues are to be effectively addressed.

Securing an integrated future

For a supported workforce, good leadership is essential. One participant noted that in the social care system “there is a varied approach to leadership”, and good leadership is not always evident in the system. Given the demanding nature of social care work, it is essential that carers feel well supported in their roles. One participant added that “workers do not stay because of a good job, they stay because of a good manager”, and therefore, proper leadership training must be a central goal of the workforce plan.

A practical solution suggested by one of the network members to combat low recruitment, retention and the poor image of the profession was a ‘social-care-first’ scheme, mirroring the successful teach-first scheme. Many other sectors have emulated the ‘teach-first’ template with great success. The aim of the scheme is to engage with young people to consider social care work as a career by espousing the value of a career in care. Such a scheme would emphasise how care work has the potential to transform the lives of dependent individuals, and the importance and value in building personal relationships with system users, improving the image of the profession. As part of the scheme, there should also be structured leadership, coaching and mentoring training, for the purpose of also transforming the quality of social care. This may serve to solve some of the leadership issues in the sector, as young and bright individuals will be well trained to manage and lead social care in the future.

Now that the NHS and social care are moving towards integration, participants noted that for a true and fair integration of the systems, employees should be paid and treated equally. One participant called for a joint recruitment scheme for the NHS and social care, with equal pay offered. It was also emphasised that NHS workers receive many ‘perks’, particularly since the start of the pandemic, which social care workers do not (including food and drinks discounts from certain companies).

Other suggestions to aid the integration of the NHS and social care workforce included social care placements and secondments for NHS staff, in which they are exposed to social care, and the richness and value of social care work. The status of care work must be elevated for proper integration of the two systems can occur, in order that social work and NHS work can be equally respected.

A large part of the discussion focused on the role of volunteers within the social care sector, and the value they bring to both paid carers and system users. Volunteers are an invaluable part of the social care workforce given that they reduce pressure on care workers, improve patient experiences, facilitate higher quality of care to drive better health outcomes, and strengthen community connections. One participant said that in the context of social care, “volunteering is a public health tool. There is a body of medical research which talks about the huge benefits for mental health and physical wellbeing for patients”. Volunteers also serve to raise the visibility of the social care sector.

Since the start of the Covid-19 pandemic, the UK has seen an unprecedented rise in the numbers of people volunteering in their local communities. During the pandemic, the UK had 12.4 million people volunteering in their local communities. 4.6 million of these were first-time volunteers. Currently, the UK has a window of opportunity to make the most of the interest in volunteering to reduce the immense pressure on care workers.

As part of the workforce strategy, there needs to be investment to drive the volunteer sector, for the wellbeing of the social care system and its users. However, time is undoubtedly of the essence; as one participant emphasised, “there is an urgency to the conversation we are having. As Covid dissipates, what we don’t want is for people to go back into the corners of their community and not come out again to contribute.”

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Spring Statement 2022: Key takeaways for health and care

By Gabriel Blaazer

While many of the measures in Rishi Sunak’s statement were welcomed, health leaders warn the government must go further to safeguard public health amid a spiralling cost of living crisis.

The Chancellor delivered his Spring Budget to the House of Commons today, in a statement dominated by events in Ukraine and the rising cost of living crisis. While there was little mention of health or social care directly, several measures announced pose significant implications for the health of the nation and the NHS workforce.

There was welcome relief for many of the lowest-paid, as the government announced the raising of the NI contribution cap by £3,000 (rather than the £300 initially suggested), from £9,500 to £12,500. According to the government’s own figures, this will take around 2.2 million people out of contributing to the Health and Social Care Levy entirely. Some 50,000 businesses (those who employ four or fewer people) are also projected to become entirely exempt from the contribution, thanks to an increase in the Employment Allowance.

Although welcome to those continuing to be hit by the cost of living crisis, these tax cuts represent an annual £6 billion reduction in treasury tax receipts. With the Health and Social Care Levy initially aimed at raising £11.4 billion a year over the years 2022-2025, the details of the Spring Budget seem to imply a 52 per cent reduction in that figure, at least in the short-term.

In mitigation, the government also announced “that it will double the NHS efficiency target from 1.1 per cent to 2.2 per cent a year, freeing up £4.75 billion to fund NHS priority areas over the next three years, and ensuring that the extra funding raised by the Health and Social Care Levy is well spent.”

Mr Sunak also announced a 5p per litre cut in fuel duty, a move that will benefit healthcare staff, such as district nurses, physiotherapists and midwives, who rely heavily on their cars to deliver domiciliary and community-based care. The cut, however, falls short of action called for by the NHS Confederation and NHS Providers in a recent statement.

Health leaders welcome tax cuts but call on government to do more

Responding to the Chancellor’s Spring budget, NHS Confederation Chief Executive, Matthew Taylor, said: “Health leaders broadly welcomed the additional funding for health and social care in the Chancellor’s Budget last October and recognise the importance of putting this investment to best use but the world around us is very different now.

“This comes as the NHS is already operating with reduced capacity, very high bed occupancy, and 110,000 vacancies, which will compound how much its services can identify further efficiency gains. Also, our members are very concerned by how hard individual NHS staff members will be hit by this cost-of-living crisis.

“A concession has been made in the fuel duty reduction, but we need to see the Treasury go further to shield community-based healthcare staff from soaring prices at the pumps as they rely on their cars to see their patients, including those who are housebound. A lot is uncertain but as the cost-of-living impact bites the Chancellor must be live to the increased strain and pressure it will put on the NHS in his next Budget this autumn.”

Nigel Edwards, Chief Executive of the Nuffield Trust, said: “Amid a cost of living crisis, it is not surprising that the Treasury will be scrutinising the increased spending on the NHS raised by higher taxes and looking for cost efficiencies.

“Changes to national insurance threshold announced today will provide some welcome support to low earners and will not reduce the amount of money already committed to health and care. But by choosing to put tax cuts above spending the Chancellor has made it less likely that health and care will see any further increases in funding during this parliament.

“This underlines that, despite a boost from the levy, the NHS will still face tight budget constraints. Funding increases to the NHS’s core budget become less generous in each of the next three years, which is why the Chancellor has doubled the annual efficiency target to 2.2 per cent. In reality, however, NHS trusts will need to find even more room for efficiency than that, as at the same time there will be steep reduction in Covid support despite the fact this cost pressure is likely to remain in place for some time yet.”

Jo Bibby, Director of Health at the Health Foundation said: “Today’s announcement shows that the government has yet to fully grasp the pandemic’s stark lesson that health and wealth are fundamentally intertwined. Despite the measures set out today, household incomes are set to fall by 2.2 per cent in real terms in the coming year.

“The pandemic has stretched the financial resilience of many families to its limit. Many have run down their savings or increased debts to cope with the impact of Covid-19 and measures to contain it. And there is no sign that there will be any let up with CPI inflation set to peak at 8.7 per cent at the end of the year. This continuing rise in cost of living will force increasing numbers to choose between essentials that are vital to living healthy lives – such as housing, heating, and food – or being driven into problem debt.

“A government that truly valued the nation’s health would have gone further today to protect the most vulnerable families from this latest economic shock. The increase to National Insurance thresholds is significant but fails to target the poorest households. There has been no action on benefits, while the additional £500 million for the Household Support Fund falls well short of what is needed. Higher inflation will also erode planned spending on public services which support health. The government should be investing more to protect people in the here-and-now, as well as building greater resilience against future threats to our health.”

How integrated care systems can improve digital inclusion

By Gabriel Blaazer

Sarah Boyd, Head of Digital Experience and Transformation at Norfolk & Waveney Health and Social Care Partnership (NWHSCP), explores how her integrated care system (ICS) is using digital health to improve patient inclusion and help reduce health inequalities.

Health inequality is a growing problem but is still too often discussed separately from the core business of the NHS. Patients are treated through siloed care pathways, with conversations about why some populations have poorer health outcomes often treated as an aside.

The pandemic brought this into greater focus, especially around digital inclusion. Technology rolled out across the NHS in response to Covid-19 often widened the gap between those who could access online services and those who couldn’t.

The benefits of ICSs

When it comes to digital inclusion, there is little doubt that ICSs offer a huge opportunity to deliver more equitable access to healthcare and improved health outcomes for those previously underserved by the health system.

NWHSCP is a new type of organisation, working as a system across the Norfolk and Waveney region. Operating across the public sector, along with health and social care, councils and with voluntary organisations, presents an opportunity tackle health inequality and exclusion in a person-centred way.

The ICS allows health leaders to work across organisational boundaries, to test assumptions about exclusion, and to leverage the work that happens at the level of individual places.

Fixing existing digital inequalities

At every stage, NWHSCP are ensuring that their digital projects address digital inequalities. By implementing a pan-public sector hub-and-spoke model that provides personalised support to excluded groups, their plan is to gain the wider benefits of digital inclusion by engaging people – not only in health services – but more broadly in society.

For example, if a GP detects that an elderly person in their care is socially isolated, they can refer them to a central digital inclusion service. From there, they may be passed to a library or volunteer service who are able to provide connectivity or a 5G-enabled device, along with the ongoing support to use it. This allows the patient to order repeat prescriptions, but also to food shop online or video call family and friends, with positive benefits for their wider health and wellbeing.

“Creating an environment in which every service is digitally inclusive offers benefits not just to individuals, but also to wider society”

Asking people to go to an appointment at an unfamiliar location can create unnecessary barriers. As it proceeds, the ambition of NWHSCP is to work towards using services that people already access to provide a trusted contact point. If patients are already known to a church group or domestic violence shelter, for example, they might receive support there.

Through community partnerships, ICSs can build a network of digital tools and skill provision. For example, if a partially-sighted person, or family member, needs a speech-to-text reader, NWHSCP can point them towards their trusted toolkit. Once a person has access to this network, they can then download tools freely, ahead of their health needs.

Building an inclusive service

Creating an environment in which every service is digitally inclusive offers benefits not just to individuals, but also to wider society. As the Good Things Foundation’s Widening Digital Participation report found in March 2020, digital inclusion pays for itself in better mental and physical health, and stronger participation in the economy. For every pound spent, £6.20 is made back.

With this in mind, ICSs can leverage skills found in the private sector to identify new ways to increase inclusivity. Companies in the space include ThriveByDesign and CardMedic, an award-winning digital tool that provides instant access to communications options to improve engagement with healthcare professionals.

CardMedic is designed to help patients with a language barrier, visual, hearing or cognitive impairment, or to communicate through PPE and is unique in its space.

One issue with digital inclusivity tools is that they’re often seen as only affecting excluded communities, but digital inclusivity applies to everyone. Many people often struggle to retain emotionally-sensitive medical information, such as details about a cancer diagnosis. Tools like CardMedic allow any patient to review the basics of a hospital procedure or consultation – helping them to feel more secure in their care.

Applying innovation

Through pulling together with public sector and voluntary organisations, NWHSCP has built a strong, interconnected and multi-disciplinary team to implement their digital transformation agenda. As ICSs move towards statutory footing, the hope is to build on their initial successes though good recruitment and the implementation of innovative technology.

But there is only so much one system organisation can achieve on its own. To maximise the potential of integrated care systems, the NHS will require a national system for picking up on digital innovation. It should not be up to individual ICSs to find products, such as CardMedic, themselves. Digital inclusivity should be available to all.