The care we need

This article is from Our Labour, Our Communities – a pamphlet of 10 essays by Labour PPCs, published by LabourList in partnership with Lisa Nandy MP

If the litmus test of a civilised society is how it treats its elderly, then the daily battles of those struggling to fund, or in many cases even to find, appropriate and adequate care and support are testament to our collective failure to pass it.

The fact that something has to be done about our dysfunctional care system is not in doubt. Since the turn of the century, two commissions, five white or green papers and three consultations have sought to address the issue of how the non-medical needs of an ageing population can best be met. The 2014 Care Act, the first serious attempt to address the problem in a generation, undoubtedly represented progress but of a particularly languid kind that fell far short of the challenges we face.

Our social care system therefore remains in crisis. It is defective, chronically underfunded and for those attempting to navigate it, often byzantine in its complexity. There is insufficient focus on prevention and the early intervention support that would keep older people out of hospital and in the community. Tighter rationing – the inevitable result of meeting rapidly growing need with shrinking council budgets – has resulted in hundreds of thousands of older people with “moderate” needs (like help with getting up, washed, dressed and fed) without access to assistance. Care workers are demoralised, often poorly trained, paid the bare minimum or less, and likely to leave the sector as quickly as they entered it. The proliferation of rushed 15-minute care slots is dehumanising those who receive it and the hard-pressed, largely female homecare workers that deliver it. The list could go on.

The financial and emotional shock that millions of families up and down the country face when confronted by this system is profound. Instead of getting the help they need, many find themselves caught in a confusing, unfair and deeply flawed structure that too often is responsible for untold distress and despair. Without urgent changes to ensure that older people receive effective and sustainable care, not only will that suffering continue but the already fraying compact between generations will deteriorate further and our NHS will buckle under the strain as it attempts to pick up the pieces.

Creating a care system that is fit for the 21st century at a time when the nation’s finances are under severe pressure will require imagination and radicalism. It calls for action on a number of separate fronts, from giving individuals, families and communities a far greater say in, and measure of control over, the care and support they receive to ensuring that an expanding care workforce receives the decent pay, working terms and conditions that are essential to the delivery of quality care. On a more fundamental level, the creation of an effective and sustainable care system requires wholesale reform of the fragmented services currently tasked with meeting increasingly complex combinations of physical, mental and social need and a fundamental shift in what we as a society understand by care so that we are able to meet the long-term challenges of an ageing society.

Social care provision today is still essentially rooted in the historic separation between healthcare provided by the NHS (funded from general taxation, available to all, and free at the point of use), mental health delivered in secondary services on its fringes and social care provided by council-run services (means-tested and increasingly restricted to those with critical or substantial needs). This postwar settlement no longer reflects the needs of an ageing population, the changing burden of disease, or rising patient and public expectations.

Overhauling that settlement requires an end to the false division between the NHS and social care and a move toward the provision of whole-person care in all settings – physical, mental, and social, from hospital to home. Such a change is necessary not only to make navigating the care system simpler – one point of contact, one care co-ordinator and one team – but also to reduce waste and inefficiency. The latter can’t be achieved by simply transferring money between hospitals and councils to plug gaps in provision as the “Better Care Fund” has set out to do. It can only be secured through truly integrated budgets, teams and services.

I’ve seen at first hand as a local councillor in the Royal Borough of Greenwich how true integration can transform people’s experience of care. Our award-winning Greenwich Coordinated Care model, developed by the Council in partnership with NHS Greenwich CCG, Oxleas NHS Foundation Trust and the local voluntary sector, has broken down old institutional silos so that care can be seamlessly ‘wrapped around’ an individual’s specific needs. The model has not only improved the quality and efficiency of care but has helped reduce hospital admissions and delayed discharges thereby delivering significant savings for taxpayers. It’s an example of what innovative reform focused on prevention, early identification, and care coordination can achieve.

Truly integrating care so that services are fully joined up is essential if we’re to prepare our care system for the future. But we also need to more profoundly reassess what we understand by need and care if we’re to shift the focus of services towards meaningful prevention. Crucially, we need to do more to address the worrying rise in loneliness and social isolation that is the inevitable by-product of a society in which growing numbers of older people live alone without extended family nearby. We too often mistakenly view social care simply as physical and health needs rather than social and emotional ones. Yet the loss of small, everyday interactions with friends, family, colleagues, neighbours, and passers-by can play a major role in deteriorating health.

We need to support innovative ways of addressing this problem, not simply by reaching for statutory services but by supporting communities and local networks in making a difference. There are already some outstanding examples of such practice around the country. For example, Leeds’ system of ‘Neighbourhood Networks’ provides everyday help and social contact that keeps older people socially and physically active and reduces pressure on local NHS and social care services. Yet such initiatives are still too few and far between and many are extremely fragile. We need more of them and they require sustained investment and the support of government.

The crisis in our social care system is one of the biggest challenges we face as a society. We have both a responsibility and an opportunity to tackle it and build an effective and sustainable care system for future generations. If we seize the challenge we can make sure that for our families, and for us, old age is something to be looked forward to rather than feared as it too often is today.

Matthew Pennycook is the PPC for Greenwich and Woolwich. You can read this and the other essays in this series in our pamphlet Our Labour, Our Communities.