The Better Care Fund is not the investment we sorely need in social care

Edmund Stubbs, 13 May 2015

The most prominent reason why the NHS is today struggling to remain sustainable is the increased numbers of the elderly who are surviving longer with chronic diseases. The popular phrase that ‘the NHS is a victim of its own success’ is truly applicable here.

Many of these elderly people are in great need of the social care provided by local authorities. However, local authority spending on social care fell in real terms by 17 per cent during the term of the previous government. We are now in a position where only those judged to have ‘substantial’ or ‘critical’ needs will receive taxpayer funded services. Effectively, around 500,000 people who would have received local social care in 2009 are no longer entitled to it.

This has led to a large number of demoralised care workers, often employed on zero-hours contracts, who are not paid for their time travelling between patients and who are constantly redeployed so that they do not get to know individual patients. These individuals, as well as those who work in chronically understaffed care homes, often feel that they are not able to provide adequate care to prevent their patients from deteriorating; a sentiment shared by caring family members, often elderly themselves who cannot cope, unaided, with the demands of a dependent person from whom they have little or no respite. Carers are themselves put at risk of mental and physical health problems as a consequence,

The government’s only true public commitment to social care comes in the form of their Better Care Fund. This £5.3 billion resource, formerly known as ‘the integration transformation fund’ is intended to facilitate better ‘joined up services’ and thus help patients be treated in the most appropriate place and thereby benefitting from a smooth ‘treatment pathway’.

While the better care fund aims to ensure well managed hospital discharges and relieve pressures on urgent and emergency care, it also aims to provide better data covering both health and social care and thus enable more ‘joined up’ care planning. However, only one of the criteria used to judge how well the Better Care Fund is operating, that of ‘delayed avoidable admissions’, actually measures how the scheme might be preventing people in care from becoming ill in the first place. The other criteria of the scheme address care quality and patient experience, which, although tremendously important, are not what will enable the NHS to adequately respond to the huge and increasing demands for its services.

Much of the Better Care Fund’s budget is not new money. Some was already allocated to CCGs, and some was transferred from health to social care. Richard Humphries of the King’s Fund claims that instead of using this small fraction of overall health financial resources to ingrate health and social care, we need instead to reform the entire funding mechanism between both services.

The forecast existence of a £30 billion funding gap in NHS budget by 2020 has become a commonplace, a similarly predicted £4.3 billion shortfall for social care is less well known. If the new government intends to continue its programme of fiscal reductions during the next parliament, it must realise that simply better facilitating the joining of two underfunded entities, health and social care, will not help alleviate the demands on the NHS.

We do indeed need better integrated health and social care but what we need more is to save the NHS partly by investing in care in the community, and particularly with regard to our elderly; managing their chronic conditions effectively to prevent unnecessary hospitalisations when their conditions reach crisis point due to neglect. Any further real-terms cuts to local social care budgets will simply make this more difficult, and consequently, our acute health services will remain overstretched and the NHS less sustainable.

Edmund Stubbs, Healthcare Researcher, @edmundstubbs1