Social care: The crunch beckons

We are days away from the Government’s spending review and a potential radical recasting of the provision of social care across England and Wales.

I’ve spoken to many people who feel that the system is not working for them and that their family members fall between hospital care and local council social services. We need to get better at anticipating the health and well being needs of older people, rather than patching individuals up when their health has deteriorated to the extent that they need hospital admission.

I think that a good place to start would be planning services by looking at peoples’ lives as a whole, such as bereavement or the loss of mobility. Many of WRVS’ services provide an ongoing connection with older peoples’ lives and allow us to detect changes in individuals’ mood, physical health or wider circumstances that may impact on their health and well-being weeks or months later. Central to our model of care is the deployment of our volunteers, who use their local insights to make the delivery of this care personalised and sensitive to individual needs and circumstances.

Local decision makers, such as councils and local authorities, now need to make the investment in services and support for people with low care needs, given the growing evidence that these services can make a substantial difference in avoiding or delaying major health problems. The House of Commons Health select committee concluded that the existing system of social care is unfair to carers; too variable and failed to sufficiently prevent or delay ill-health.

There are encouraging signs that ministers may wish to get to grips with this problem . At the Conservative Conference, the Health Secretary announced that the National Health Service (NHS) would be given responsibility for the care of people within thirty days of their discharge from hospital and this was backed by an extra £70 million pounds. The NHS White Paper said that the existing powers to encourage joint working between local authorities and the NHS would be simplified and that local authorities would be given a new duty to promote public health.

But these developments are taking place at the same time as councils are expecting to have to make big cuts in their care budgets. Most councils have already restricted their services for people with critical or substantial care needs and we are already hearing that councils across the country are tightening the criteria they use to decide who gets care.

Some key players within social care world have recognised that major new strategic thinking is required in order to avoid and have talked of a recasting of provision rather than crude attempts at retrenchment. The Local Government Association has called for a range of local decision makers to work more closely together to focus on ‘upstream’ prevention.

I hope that ministers will clearly communicate their level of ambition about the expansion of preventative care to health and social care commissioners. This is what WRVS thinks that ministers could do now:

• the Department of Health could direct the release of further resources from the NHS budget to pay for preventative services, reinforcing the point that better health does not necessarily require NHS delivery
• Ministers could issue stronger central guidance emphasising the value of preventative care services and that these should be a major focus for joint working arrangements
• they could amend the criteria that local authorities use to decide who receive services by specifying that some people need support to prevent them deteriorating later in life.