Breakfast Seminar

Paul Burstow,

September’s Care Conversation heard from Chair of Tavistock and Portman NHS Foundation Trust, and former Health Minister, Prof Paul Burstow on the subject of ‘Social care – a crisis in slow motion’

“Social care is an understated but very important policy area that doesn’t get the attention it deserves in public discourse and the media,” Paul Burstow told Care Conversation delegates. “We’ll be seeing the consequences of that in the months and years to come.”

The legal framework for adult social care had been in place since 1948, he said, since which time an endless process of ‘tinkering’ had led to a confusing and often contradictory structure. The 2014 Care Act had been enacted not only to simplify and consolidate the law but also to create a system focused on wellbeing and the needs of the individual – including family carers. “The aim was to help the individual maintain a life – it wasn’t just about a bundle of services,” he said.

A subsequent report, Care Act for Carers – One Year On, however, had identified a gap in perception between “what local authorities thought they were doing” and carers’ own experience, with 65% of carers not having had an assessment and 37% of those that had failing to receive a follow-up support plan. The resource constraints local authorities were operating under meant that many were finding ways of “not enacting this legislation to the letter”, he warned.

In terms of quality, however, 68% of services had been rated ‘good’ by the Care Quality Commission (CQC) earlier this year. “The CQC painted a positive picture of a re-balancing of the system between commissioners and suppliers, and the system is still delivering remarkably good results despite the pressure” – pressure to which smaller providers were particularly vulnerable, he stressed.

“All of the discussion around social care tends to focus on the demographics,” he told the seminar. “By 2048 when the NHS – if it’s still there – celebrates its hundredth birthday, there are likely to be around 100,000 centenarians living in this country. That’s a huge shift.” Although many of the aging population were maintaining their independence despite living with chronic conditions, a smaller percentage needing care was still “a smaller percentage of a much bigger population”, he stated. “The system really feels like it’s running on empty. It’s not just the spend that’s fallen – activity has fallen as well, and the funding gap is growing.”

The government had taken some measures to address these concerns, he said, including more money for the Better Care Fund and the introduction of powers to raise additional finances, although these were arguably not particularly well targeted. “According to the King’s Fund and Nuffield Trust, by the end of this Parliament we’ll be spending 1% of GDP on social care. That’s a significant fall in an already not very big budget.

“It’s not just about an aging population,” he stressed. “It’s also about the workforce,” with demand for the overall health and care workforce increasing twice as fast as the rate of population growth.

“So what are the consequences of all this? One is that many more providers are likely to consider their position, particularly in the public sector.” This would take the form of a gradual attrition, he said, alongside a continuing increase in the number of care businesses seeking top-up payments from individuals. “There will be rationing, delays in assessments, and the ever-present tensions between local authorities and the NHS will continue to be a fault-line.”

One positive was that MPs were fully aware of the challenges, although this had not “translated into social care getting a look-in in Parliament”. In terms of public perception, awareness tended to be limited to people with direct experience, while the media only took a real interest when there was a scandal.

All of this was in stark contrast to the NHS, he said. “There’s a real passion for the NHS – people mobilise. But when it comes to social care there’s confusion, lack of understanding, lack of clarity.” Less than 50% of the public understood that social care was means-tested, while between 50 and 60% felt it should be free at the point of use. “People tend to believe that the NHS will be there to look after them when they’re older. That’s not where the system is.”

One obstacle was that the sector could be quite inward looking, he stressed. “We have a tendency to just talk to ourselves. We need to move beyond talking to the usual suspects, and engage organisations like the WI, for example. We need to create a wider movement in society that’s talking about this. There’s a real need for a lot of activity at community level.”

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