As we await the publication of the new Green Paper on social care (before summer 2018), Jeremy Hunt, Secretary of State for Health and Social Care, has set out the seven key principles that will guide the Government’s thinking.
Quality
81% of adult social care providers are good or outstanding according to the CQC, but there are still too many people who experience care that does not pass the ‘good enough for my mum or dad’ test. There are also still cases of “demonstrable neglect.”
According to the NHS atlas of variation, there is around a 90-fold difference between the highest and lowest performing local authority areas when it comes to over 75s rates of admission to hospital from care homes or nursing homes. These “unacceptable variations” will be tackled.
“My first of the seven principles will be that we need a relentless and unswerving focus on providing the highest standards of care – whatever a person’s age or condition. This means a commitment to tackle poor care with minimum standards enforced throughout the system so that those using social care services are always kept safe and treated with the highest standards of dignity and compassion.”
Enhanced CQC inspections over the last five years have helped the NHS on a journey of improvement and those principles have been extended to the social care provider sector. Reviews have highlighted variation in performance between local authorities across a range of measures.
“So we now need to ask whether the time is right to expand that approach, and one of the questions the Green Paper will pose is whether we can build on the learning from the introduction of independent Ofsted-style ratings for providers to spread best practice to commissioners as well.”
Whole-person integrated care
Full integration of health and social care centred around the person has been proven to enable people to stay longer at home, remain healthier, more independent and needing fewer hospital services.
Users of the social care system should have just one plan covering all their health and social care needs based on a joint assessment by both systems.
Jeremy Hunt announced new pilots in Gloucestershire, Lincolnshire and Nottinghamshire: “which will mean that over the next two years every single person accessing adult social care will be given a joint health and social care assessment and - critically - a joint health and care and support plan, where needed.”
He added: “Integration must never be a bureaucratic exercise that makes life easier for professionals but makes no difference to people using the services. We will fail if we only join up the structures – we have to focus relentlessly on joining up the actual care experienced by vulnerable adults and service users on the ground - and these three pilots are intended to be trailblazers for how to get this right.
Control
It is important to give individuals and families the ability to direct the care they receive and autonomy to lead the lives they want.
“I want to turbo-charge progress on integrated health and care budgets, making them the norm and not the exception when people need ongoing support. Today I can announce that we will be consulting on Personal Health Budgets, in order to achieve better integration for those with the greatest ongoing social care needs as well as health needs.”
In the three pilot areas, over the next two years, everyone with a joint care plan will also be offered an integrated health and care personal budget.
Control also means transparency and access to reliable information. The Competition and Markets Authority last year highlighted a lack of transparency in the current social care market. “We need to make sure that anyone who needs to can get the right information to make a meaningful comparison between services so that they end up with a fair and straight deal on their choice of care provider. This isn’t just fairer, it will also spur quality and innovation in the sector.”
Workforce
We need more coherent workforce planning - that is better aligned with the planning now being undertaken by the NHS – and must respect and nurture the social care workforce, who are often highly-skilled but typically also the lowest paid. Financial support therefore needs to be matched to a recognition of the value of this work.
“It is time to do more to promote social care as a career of choice and to ensure there are better opportunities for progression into areas like nursing which span both the health and social care sectors.”
More integration between health and social care will mean more people moving between the two systems and opportunities should be open to all.
“We need to recognise that people move between the NHS and social care systems - and will do more so as the two systems join up. So part of our thinking must be to think about health and care workforce issues in a joined up way. I can therefore confirm today that later this year we will not now be publishing an ‘NHS 10 year workforce strategy’ – it will be an ‘NHS and social care 10 year workforce strategy’ with the needs of both sectors considered together and fully aligned.”
Supporting families and carers
The needs of carers will be made central to the new social care strategy, to make it easier for people to care for a loved one.
“Over the past months we have been listening to the views of carers so ahead of the Green Paper we will publish an action plan to support them.”
There is also a pledge to tackle the “epidemic of loneliness.”
The department will work with Tracey Crouch, appointed as Minister for Loneliness to address the underlying causes of loneliness by building an active and creative partnership between the state, individuals and wider civil society.
A sustainable funding model for social care supported by a diverse, vibrant and stable market
Person-centred care is meaningless if there is no choice of suitable, high quality care available to the patient locally.
“We have to make sure that we have a vibrant and diverse base of care services for people to draw on. So the sixth principle running through our Green Paper will be the question of how we ensure a sustainable financial system for care, delivering a stable and vibrant market which delivers cost-effective, quality services for all including the debate we need to have with the public on the challenges of sourcing additional social care funding.
“We should not assume that the best long term answer will be necessarily the same for different age cohorts. There may be changes that are equitable and achievable for younger people that would not be either of those for the generation approaching retirement. And part of the outcome of this process must be much greater public understanding of where the costs – often inappropriately – currently lie both for the state and individuals in every age cohort.
“We also know the economics of the publicly funded social care market are highly fragile so we need to transform and evolve our models of care.”
This will also involve looking at innovation, technology, new models of care and services.
“A more vibrant and diverse market offer will give people greater choice and more effective support. But it is also vital because if we do nothing to support people’s needs more creatively or efficiently, the cost of simply delivering these services today will double in a decade.”
The Green Paper will “jump start” the debate about sustainable, long-term funding for social care.
Security for all
The Green Paper will bring forward ideas to reform the current charging system for care, which can vary tremendously. The government maintains that a shared responsibility for paying for care – a partnership between the state and individuals - is the right approach but is looking for a better way of spreading that cost.
“The way our current charging system operates is far from fair. This is particularly true for families faced with the randomness and unpredictability of care, and the punitive consequences that can come from developing certain conditions over others.
If you develop dementia and require long-term residential care, you are likely to have to use a significant chunk of your savings and the equity in your home to pay for that care. But if you require long-term treatment for cancer you won’t find anything like the same cost.
So people’s financial wellbeing in old age ends up defined less by their industry and service during their working lives, and more by the lottery of which illness they get. We therefore need a system that includes an element of risk-pooling.”
Read the full speech here.
