Are the Government’s guiding principles for better social care a step in the right direction?

April 2018

By Joel Charles, Deputy Chief Executive, Future Care Capital

Jeremy Hunt has a keen eye on his political legacy. Walking into Downing Street during the January reshuffle, he made a pitch that took some by surprise. His appointment as the Secretary of State for Health and Social Care was a clear signal that he saw an opportunity to tackle one of the growing domestic challenges facing the UK – the need for a new long-term plan to address the growing demands of our ageing population. His move should not have come as a huge surprise. We predicted that Jeremy Hunt would look to enhance his role and include social care in his title; big policy challenges excite and motivate politicians. His recent speech about the seven principles that he said will guide the Government’s forthcoming social care consultation reinforce the view that he is taking the challenge seriously. Jeremy Hunt and his Ministerial team need to deliver a new plan urgently; rapid demographic change is compounding the challenges faced by local health and social care providers who are already stretched.

Although the seven principles offer a blueprint to map how the social care consultation will be structured, the test will be whether these principles stack up as a good way to help deliver meaningful long-term solutions.

Better quality and standards is the Government’s top principle to address and ending the variation of quality and outcomes across the country is something Jeremy Hunt wants to pursue. He has suggested building on the Ofsted model applied to providers of social care, such that commissioners of social care services might also be subject to CQC assurance in the future. It is important that quality control measures do not become unnecessarily bureaucratic – the sector must be given the breathing space to improve standards.

There have been various attempts to pin point how best to tackle health and social care integration. The Government intends to focus on a whole-person integrated care approach. Whilst there is recognition that the current system is fragmented and difficult to navigate for individuals and their families trying to manage health and care needs, this approach could also address some of the far wider concerns. It could, for example, enable a greater focus on compressing morbidity in order to reduce the amount of time that people are unable to live in good health.

Individuals increasingly want to take greater control of their own health and care needs, and Jeremy Hunt has signalled the need to introduce greater personalisation so that people can lead the lives they choose in later life. Specifically, the Government plans to look at this area by consulting on Personal Health Budgets. Personalisation is nonetheless tricky to deliver via the NHS as a large national organisation geared up to deliver standard health and care provision. One area of potential focus to achieve personalisation is how to instil a culture across health and social care provision that puts individual need before targets. If personalisation is going to work, central targets will need to take account of this policy change.

The challenges associated with the social care workforce are, by now well-rehearsed, so plans for a joint 10-year NHS and social care workforce strategy are long overdue and a step in the right direction. The National Audit Office has scrutinised the Government in this area, it claimed:

“The Department of Health and Social Care is not doing enough to support a sustainable social care workforce.”[1]

Recruitment and retention challenges are well known in the social care sector. Adult social care workforce turnover rates have increased in the last six years according to Skills for Care.[2] This strategy could be an opportunity to deliver a better career proposition, with improved progression routes and a new plan to attract more people to pursue a career in social care. In our recent response to the Health and Care Workforce Strategy Consultation, we looked at supporting the development of enhanced benefit packages, offering help to access low cost transport and affordable housing. This is something that could form part of the Government’s 10-year strategy. We also said that consideration should be given to the potential for national bodies to further promote, develop and articulate training opportunities in social care.

Supporting families and carers who struggle to juggle their care responsibilities has been reviewed on countless occasions by previous Governments of different political colours. The current Government says that it intends to put carers needs at the heart of their new social care strategy. Carers UK welcomed the fact that support for carers is one of the key principles, but they also called for an urgent injection of funding to help families and friends who are over-stretched caring for loved ones.[3]  Employers and the Government working together could make a huge difference, offering targeted support through flexible working and technology so that people can better manage their work-life-care balance. Now is the time to deliver something meaningful for carers, if the consultation does not come up with any additional concrete support, a growing number of people with care responsibilities will continue to struggle.

The last two principles outlined by the Secretary of State were sustainability and security. Establishing a sustainable financial system for social care is no easy feat. The indications are that Jeremy Hunt recognises that an approach that factors in the differing demands of certain age groups may represent the optimal way forward. Technological innovations have a key role to play in transforming the way social care is delivered across the country. The Government’s Industrial Strategy will play a significant role and the £98 million innovation fund set up to support healthy ageing could kick start fresh ideas to deliver new ways of working. For the Healthy Ageing Grand Challenge to be successful it will need political backing, so that what results is truly ‘mission oriented’ in keeping with UCL’s related Commission which is looking to solve the Grand Challenges.

Providing reassurance and a greater sense of security in the social care system is a crucial factor. The Government wants a system that has a greater element of risk-pooling and has indicated that it is looking at ways to address financial anxiety when individuals are faced with managing expensive long-term conditions in later life. Strengthening the principle of shared responsibility is something that Jeremy Hunt intends to major on. He has a significant amount of work to do to reassure the public that his plan will offer long-term security for people managing multiple long-term conditions in later life.

It is still too early to say whether the Government’s guiding principles for the forthcoming consultation exercise will lead to a new long-term settlement for health and social care. Overall the principles touch on the usual areas of concern that affect health and social care provision, and it is perhaps fair to say that the guiding principles are not particularly radical. Vic Rayner, the Executive Director of the National Care Forum, recently pointed out:

“The weight of ‘stalled reform’ sits on Jeremy Hunt’s shoulders…”[4]

There are gaps around the built environment and how the health and care estate should respond to the emphasis on integration and greater personalisation. The role that automation and machine learning might also play is conspicuous by dint of its absence.

The Government must consult the sector widely and not fall foul of a silo mentality that has hampered progress in the past. Everyone committed to genuine reform must also be ready to respond constructively to the opportunities presented in the planned consultation – it represents the most significant opportunity to shape a more sustainable health and social care system in the run up to the next General Election. We now await publication of the consultation document to better understand the direction of travel Jeremy Hunt and his Ministerial team want to pursue.

References

[1] National Audit Office, The adult social care workforce in England, available here: https://www.nao.org.uk/report/the-adult-social-care-workforce-in-england/

[2] Skills for Care, The state of the adult social care sector and workforce in England September 2017, available here: https://www.skillsforcare.org.uk/Documents/NMDS-SC-and-intelligence/NMDS-SC/Analysis-pages/State-of-17/State-of-the-adult-social-care-sector-and-workforce-2017.pdf

[3] Carers UK, Carers UK responds to Secretary of State’s speech on the future of social care, available here: https://www.carersuk.org/news-and-campaigns/press-releases/carers-uk-responds-to-speech-on-future-of-social-care-from-secretary-of-state

[4] Vic Rayner, Executive Director, The National Care Forum, Tell me your dreams, available here: http://www.nationalcareforum.org.uk/viewNews.asp?news_ID=4396