The Social Care Challenge
By Integrated Care Journal-
What are the key priorities for social care reform? Rt Hon Stephen Dorrell, Rt Hon Damian Green, William Laing of LaingBuisson and Angus Honeysett from Tunstall joined forces to discuss their views on the current policy landscape.
PPP announces the development of a new State of the Nation report, ‘The Social Care Challenge: Implementing a Connected System’.
The social care challenge has remained a pressing issue for successive governments spanning decades, each promising a solution on the future financing and structures of social care. We have been waiting for them to make good on that promise since, as Stephen Dorrell puts it, “the opening night of Lazarus”. Or, more precisely, since Tony Blair addressed the Labour Party Conference in 1997 on the need to solve social care.
In the long and undistinguished history of social care, Damian Green, former First Secretary of State, is first to admit that he was “part of the problem rather than part of the solution”. This is true in that he held some responsibility for trying to get the different parts of Whitehall to come together on the future of social care during his time in office. Since then, Damian explains, this responsibility shifted onto Jeremy Hunt, who remained unsuccessful in managing to “get a big policy over the line”.
The Care Act (2014) represents a near miss in enshrining an upper limit to out-of-pocket care costs into law. However, as Damian explains, austerity led to the decision that the country could not afford it. The issue has sat largely unaddressed ever since. So why should this time be any different? For Damian, it is not because “Boris Johnson stood on the steps of Downing Street and said this is one of the things he wanted to solve”. Rather, it is because “Covid-19 has shone a light on the sector, on the way we as a society treat elderly people who require residential care”. He argues that the nation’s consciousness is now at a level where this will not be accepted, we cannot simply return to the “old normal”.
Priorities for reform
Reforming social care policy is not an issue on which there is disagreement that something must be done. Rather, it is an issue on which Government cannot agree what is to be done. With this in mind, what should the priorities be for social care reform?
For Damian Green, the priority needs to be reforming how we fund social care. “The financial fragility of private sector operators has increased and the almost-permanent financial fragility of the local authority sector, in terms of operating care homes, is not going to get much better at any time in the near-future”. Things are gradually getting more difficult. There is a need for more radical action in which government has allocated extra funding every year to tide the sector over. “The era of sticking plasters over the problem is coming to an end”.
As Chair of the PPP State of the Nation report ‘The Social Care Challenge: Implementing a Connected System’, Damian has identified four priority areas for social care reform: integration, innovation, infrastructure and funding.
In terms of integration, Damian highlights the obvious unfairness in what NHS provides and what local authorities can provide, as well as the injustice that care provision is dependent on disease. “If you’ve got cancer, the NHS will treat you. If you’ve got dementia, the NHS will treat you, but won’t give you any of the surrounding care”. We must seize the opportunity provided by the Government white paper and “make a reality of integration, not least between the NHS, local authority care and private care”. Another area of integration must be between domiciliary and residential care, so that “more people can stay in their own homes for longer”.
Reforming social care infrastructure should be seen as part of the wider preventative health agenda. “The NHS has been good at curing people, but our health system has been lousy at preventing people needing treatment in the first place,” reflects Damian. Similarly, our housing system has not delivered enough homes in which people can live for longer. It is important that we increase our supply of age-specific housing in order to support aging in place – both through new-builds, home adaptations and retirement villages. “Your last home is very unlikely to be your largest home. But it should be your best home. It should be something you’re proud of. Something you want to live in”. Damian also touches upon the perennial issue of the workforce, underlying the impact Brexit will likely have on this issue and the need to make a career in care more desirable for British workers.
In terms of innovation, “we’re talking about shaping the [care] economy around a digital spine” says Damian. The various technological improvements in AI and big data represent a huge resource for remote patient monitoring and self-management.
Angus Honeysett, Head of Market Access at Tunstall Healthcare, which partnered with PPP to produce a State of the Nation report on Technology Enabled Care Services (TECS), builds upon this view: “The pandemic has proven beyond doubt that MedTech is vital for the future success of our health care service”. Angus emphasises the important roles of TECs in providing person-centred care. “Adding equipment to existing service delivery alone will not provide the answers”, says Angus. “Fundamental changes to care models and cultures is required, along with tailored support to meet individual needs across social care now and in the future”.
What should these fundamental changes look like? For Angus, there are four clear recommendations for social reform in the area of innovation. First, the sector should receive greater support to become truly technologically enabled, and the Government must ensure a minimum technology standard across providers. Secondly, he emphasises the need for Government to support digital infrastructure in order to assist providers in the switchover to tech platforms. Thirdly, he calls for the digital upskilling of the health and care workforce “to ensure the transformational benefits of digital technology are realised and aligned with cultural change”. Lastly, Angus stresses the need for Government to drive integration through digital investment and support collaboration between all health providers.
Historically, Damian explains, there have been two broad proposals for reforming the funding of social care – either rolling up care into the NHS and treating everything as free at the point of use, or creating a separate national care service. However, he admits that both are unlikely “both for reasons of expense and practicality.
“The bulk of residential care is provided by the private sector. Nationalising all of them would cause untold chaos in the sector, at just the point where we don’t need it. ” Instead, Damian suggests a ‘Dilnot-style solution’ combined with an insurance-based proposal.
In this instance, a new funding model must be based on two basic principles. We must strike a proper balance between collective responsibility and personal contributions to the costs incured over the last few years of life. The second principle, which Damian hopes will become relatively uncontroversial, “is that continuing to fund this out of council tax is going to be intolerable for local authorities”. As such, he suspects that “national taxation will act as the bedrock of what we contribute”.
William Laing, Founder and Chair of LaingBuisson, further elaborated on the Dilnot proposal. For William, the Dilnot analysis is correct “in the sense that long-term care is the only remaining uninsurable life event leading into catastrophic costs”. As such, he argues that “this can be viewed as market failure and, therefore, a reason for the state to step in” and offer a mechanism that can protect individuals against such costs. However, in terms of Dilnot’s prescription, William has major concerns about the financial strain this would put on the care home sector, particularly in non-affluent areas. He explains: “the introduction of a higher threshold would result in large numbers of individuals who have previously used private funding going over to public funding at much lower rates, therefore destabilising the care home sector in those areas”.
Practical, coherent and diverse
Our overarching priority in reforming social care must be the improvement of outcomes for individuals. As Damian puts it: “However polished our recommendations… if we aren’t actually improving people’s live then we’re not actually doing any good”.
Concluding the session, Stephen underlines the need for policy recommendations that are practical, coherent and diverse – “an ambition for many years and many people, but not yet delivered”. This is the challenge PPP has set itself in answering the important question mark of social care.
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