Mind the Care Gap Campaign: Community health and care provision that is ready and able to meet demand

25th January 2018

Curtis-James Marshall MCIPR, Senior Public Affairs and Media Officer, Future Care Capital

Mind the Care Gap, now in its penultimate week, is looking at some of the challenges faced by those managing community health and adult social care needs at the local level.

There are currently universal calls to increase public funding for health and care services. The extent to which across the board increases, in one or the other, will help professionals working on the frontline to address gaps in care that reflects local circumstances, remains to be seen.

We need to strike a balance between health and adult social care priorities, and the particular needs of communities, to target additional resources at a local level. Future Care Capital is committed to unifying health and care provision to deliver better outcomes for everyone in our society. As our population is ageing, the pressure on local health and adult social care provision has become increasingly difficult to manage. A growing number of older people are seeking care or treatment, with ever-increasing complex needs, for a longer period of time. We need a long-term strategy in place to ensure that health and care provision is able to cope with increases in demand.

Last year alone, 1.8 million requests for adult social care support were received by local authorities from new clients – equivalent to almost 5,000 per day.[1] Local councils have consistently reduced the number of people delayed in leaving hospital for home or a community setting since July 2017 –  enabling people to receive the correct support, in the right place at the right time.[2] Frontline staff working at a local level are well placed to know what can and will work for their own communities – so what else could or should be done?

We spoke to a number of people from across the country, including staff, service users and unpaid carers to get their perspective on what they would like to see happen in their local communities.

An adult social worker spoke to us about the importance of home visits and why face-to-face support should remain as an important part of community provision:

“A telephone call assessment doesn’t give you that realistic a picture. A patient can say they’re fine, then in a week’s time they’ve ended up in hospital because they were not managing and the home environment is in absolute need of support, advice and guidance.”

Local housing schemes for older people are increasingly under strain. We spoke to Rene Baterip, a 79-year-old who lives in an enhanced sheltered housing scheme, about the standard of care support by staff and how residents are forced to look after one another:

“It has deteriorated over the years, and I find now that you have got residents looking after residents, because often staff are not here or the staff haven’t got the expertise, or its getting near going home time for the staff and they do not want to get involved.”

End-of-life care is a very emotive subject. As people enter the last few months of their life, it is essential that local palliative care is responsive to their needs. There are examples where end-of-life care is hampered because of a lack of resources.

Dr Adam, Clinical Lead for End-of-Life Care in the East Midlands, said:

“I think the district nurses are the most stretched. If someone is dying at home and they have breathlessness or pain, we have already prescribed everything they need, the link is that the district nurse needs to come out and administer that medication and that can take 2 hours on average, and if you are in pain or looking after someone in pain that is a long time. I think the service gaps are the nursing teams, people on the ground that can go out and administer.”

There is a growing sense that local health and care pressures are putting increasing strain on individuals and wider society. Doctors and charities have called for a concerted effort to drive home the public health message that exercise, a good diet and maintaining a social life should be a cultural norm amongst all generations.  The way that provision is currently resourced and organised is not working. We have consistently called for a new settlement for health and care to ensure the right services are placed on a sustainable footing and made available to current and future generations.

In our most recent report, Securing the Future, we recommended the creation of a new civil society fund, controlled locally, to help stimulate pioneering, sustainable, community-led solutions. This would help engage and empower people at a local level and provide them with the funds to resource the health and care needs of their communities. If we can get the balance right, we can build a more sustainable provision base capable of responding to an increasing demand.

[1] NHS Digital, Adult social care activity and finance report, England 2016-17 (October 2017), accessible at: http://digital.nhs.uk/catalogue/PUB30121

[2] LGA, 11th January 2018, Cllr Izzi Seccombe responding to the latest delayed transfer of care figures published by NHS England