Making adult social care a priority

Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission

Last autumn in our State of Care report to Parliament we declared that adult social care was “approaching a tipping point”. We considered very carefully how to express our concerns by setting out five tests that determined how the sector needed to change. This included levels of unmet need highlighted by Age UK and others; the variability in quality we had seen on our inspections; how services were struggling to improve; the difficulties in recruiting and retaining good staff; and how the market was operating with contracts being handed back to local authorities and the previous increase in nursing home places stalling when we know demand for complex care is increasing.

We did not feel the sector was about to immediately fall over but without action and a long-term solution we were worried there would be more deterioration in care, more unmet need and less improvement. ‎And all this would have a damaging, lasting impact on the people who matter most — people using services, their families and carers.

The recognition of the challenges facing social care is evident in the Chancellor’s Budget statement. The announcement of £2 billion additional funds over the next three years is welcome but even more welcome is the promise of a Green Paper later in the year and hopefully a long-term solution that will support good quality, person-centred adult social care now and into the future.

I am glad that there has been this recognition as the trends we identified last year have continued, for example, with Housing and Care 21 and MiHomecare exiting the homecare market completely in recent months.

There is no shortage of advice for the Chancellor, the Secretary of State for Health and their civil servants. Just a few of the blogs and comments that were hot off the press not long after the Chancellor sat down:

Alex Fox, Chief Executive of Shared Lives Plus has urged the future “must be a social care system built around serious ambition for the scale and effectiveness of community-based models which have been considered add-ons for too long.”

Chris Ham, Chief Executive of The King’s Fund has recommended that “this time, the government must break the mould and deliver the radical reforms that are so badly needed.”

A more light-hearted take comes from Simon Bottery, Director of External Relations and Policy at Independent Age who reflects on the Budget Buzzword Bingo.

I am sure there are more!

‎A word of caution though. There has been a huge focus on what this new money for social care can do for the NHS, with the HSJ reporting a senior NHS source saying “hospitals needed to be “quite lippy” about what was required to deliver reduced delayed transfers of care”.

I can understand the motivation — my colleague Sir Mike Richards highlighted only last week that “What is clear is that while staff continue to work hard to deliver good care, the model of acute care that once worked well cannot continue to meet the needs of today’s population. The NHS now stands on a burning platform.”

I also recognise that people who use health and care services, their ‎families and carers are crying out for a more joined-up system that makes life easier for them not the bureaucratic nightmare many face trying to link agencies together by themselves.

But to think that adult social care exists just to relieve pressure in the NHS by improving discharge from hospital for older people is to make three fundamental mistakes;

  • It‎ ignores the reality that a third of local authority spending on adult social care is to support working age adults.
  • It fails to recognise that a whole system response is required, with hospitals needing to address the two thirds of delayed discharges that are caused by internal issues and better partnership working.
  • And it diminishes the vital, transformative impact that good social care can have on the lives of individuals using these services, their families and carers.

We need to make adult social care the priority it deserves to be and use this opportunity for the sector to work together positively and collaboratively to ensure the needs of people using services, their carers and families are at the centre of how we use these new resources and create the long-term sustainable future where quality really does matter.