Peter Hay argues that political debate on the future of social care needs to answer far more profound questions than how much funding it needs.
With my retirement from being a social care director I have been reflecting upon twenty years in the role. In the ironic circle of time, I started out as a director just after the Royal Commission on long-term care, chaired by Sir Stewart Sutherland, hit the buffers in 1999 with a political split caused by profound disagreements on affordability.
For all the subsequent commissions, white papers and green papers, the long-term future of social care remains unresolved, a cross-party failure. As the current government clearly has limited room for financial manoeuvre, it is at least refreshing to see it prioritise social care. But that priority is not going to be delivered by one burst of funding. It will require sustained debate, together with some bravery, to find new public and personal funding for all our old age. Social care is for life, not just one budget announcement. Neither should it be fodder for a debate during the election campaign about social care and the state of NHS beds.
There are strong indications that the £2bn of additional funding announced in the last budget is too little, too late: Birmingham runs into this financial year with an existing overspend and, according to the last budget survey by the Association of Directors of Social Services, three quarters of councils are in the same position.
Not only is there a backlog of activity costs to be met, but care providers face major pressures while employment conditions for the workforce need extensive reform.
The £2bn will quickly be consumed by the backlog of demands and existing pressures, with little chance for strategic, sustained investment over the three years. The difficulties in strategic planning are exacerbated by the uncertainty over future resources.
With the NHS underpinned by an approach across five years, and Sustainability and Transformation Partnerships (STPs) moving into the same territory, we have to be able to align social care to shared time horizons if we are to plan across the whole health and care system.
Fighting the fear of old age
Resources alone will not solve the social care issues, but over the last seven years the percentage of GDP spent on care has fallen. Government needs to engage in the debate around how we will pay for care, and what constructing that care will require from us individually and within our families, communities and workplaces. As a country we have found it hard to engage with the notion of pensions as a plan for income in old age. Now we have to find ways of helping us have the debate that we fear and avoid – to confront our mortality and the frailties of old age. We need to use the priority afforded to social care by the Budget to build this public debate.
If we don’t, we will again be caught between a state system of payment that the country hasn’t been able to afford and a debate we seem unable to have. One of these has to give. The promise of the current government for a green paper is an opportunity to set out for public debate how we are all going to face the realities of more people living longer. Leaving people to find their own way through is not a solution.
Inspiration from New Zealand
In the Canterbury Health system in New Zealand, reforming health and care has focussed on our most precious asset – the time we all have on this planet. Canterbury values the the time that people have, particularly in later life, and draws measures of quality and effectiveness from this perspective.
Canterbury are honest about the pressures on their system – rising demand, tight finances and the consequences of the earthquakes. Its achievements are striking, with 20,000 fewer hospital admissions for older people than had their system performed at the New Zealand average. Their health and care strategic documents have a clarity of tiered expectations, with interlinked national, regional and local frameworks.
The urgent conversation is what do we need to do to make our society a great one to grow old in?
Focusing on wasted time has brought clarity to its priorities. Placing a stress on primary care to avoid admission and facilitate early discharge is accompanied by an apparent thirst for learning from best in class management practices such as lean and six sigma. The system has galvanised itself with an urgency that comes from placing people at the centre of everything they try to do.
Their example includes something we can all copy immediately – its leadership and learning programmes are open to everyone in the system, not just health staff, supporting the ambitions for a collaborative and empowered professional network.
So my big hope for the next round of the discussion on the future of social care is that we change the narrative from excessively talking about money to a renewed focus on effective use of resources and what constitutes good practice.
The election debate and policy-making of the next government are an opportunity to find a language and framework that resonates with the lived experience of those growing old, living with disabilities and their families. This is perhaps a chance to stop bombarding the public with messages about the “social care system” or the mechanisms that we have come up with to meet needs for conditions we don’t want to contemplate.
Instead we can use this new sense of priority to drive the urgent conversation – what do we need to do to make our society a great one to grow old in? It is a conversation that matters to all of us, and it’s about time we found ways of inviting everyone to join it.