by Grainne Siggins, ADASS policy lead on urgent care
Many of us have worked within health and social care for many years and will be familiar with the annual focus on preparing for the winter surge and funding being made available to assist with system responses.
In recent years, there has been a step change in demand for health and care services with pressures felt all year round. Social care and health staff who work in hospitals and communities understand and feel this acutely. They are increasingly subject to high levels of media and political attention during the winter surge and after the main Christmas and new year holiday period. This year was no different.
There was little recognition for the hard work of social workers, nurses, doctors and the army of care workers supporting the most vulnerable people who need support. Staff across health and social care continued to work really hard over the Christmas and new year period to ensure that people with care needs were supported in the community, or when needed within acute settings and discharged safely.
Instead, the reporting of people waiting for hours in accident and emergency, including 12-hour trolley waits, and the impact on quality of care and patient safety once again gathered media attention. The focus quickly turned to people being delayed in hospital with most media focusing on people being delayed due to a lack of social care support in the community.
The much higher number of delays due to health was often not mentioned. It is unfortunate and disappointing that interest in the positive contributions that social care makes to people’s lives every day, does not receive the same level of media attention.
ADASS and partners have continued to highlight the increasing number of older people in need of care and support with multiple long term conditions and how health partners are working together to provide personalised services at a local level. New and innovative models of care and support are emerging with an increasing focus on those shaped in agreement with local people and carers. However, innovation can only go so far, when at a time of significant increases in people requiring care and support, the funding settlement of local government and social care continues to be cut in real terms.
We all recognise and support the move to providing increased health and care services in the community, utilising acute care only when there is a medical need to do so. Whilst progress has been made to create a different and enhanced model of primary and community based care and support, it is clear that many people still remain in hospital when they could be discharged or more importantly, not be sent to hospital in the first place.
The number of people who remain in hospital longer than they need to continues to rise. Delays due to both health and social care have increased considerably, including over the past 12 months. However, over the past two years there has been a marked rise in the delays attributable to social care. In the last nationally reported figures, the main reason for social care delays was patients awaiting care packages in their own home, with delays for this reason steadily increasing since February 2015.
ADASS has continued to signal the fragility of the social care market, the considerable workforce recruitment and retention issues, and lack of funding on many occasions. This is clearly impacting on putting together packages of care for people to enable them to avoid hospital admission in the first place or to be supported at home well after their admission.
This was evidenced through last year’s ADASS Budget Survey, where four out of five directors believed that providers were facing financial difficulties, with evidence of actual failure within the provider market in the last six months, affecting at least 65 per cent of councils and thousands of individuals as a consequence. This is fuelling wider concerns about provider viability and sustainability and the quality, quantity and duration of commissioned care.
Councils are continuing to give priority to helping people home from hospital even in these difficult financial times, with directors reporting significant levels of midyear overspend as they support people with increasingly complex needs.
What is clear, is that a fair settlement for health and social care would help to provide appropriate support to the most vulnerable people in our society and carers – but the Autumn Statement and Local Government Finance Settlement didn’t provide this. As a result, we will inevitably see more older and disabled people not getting the care and support they rely upon to survive each day and an even greater toll being placed on the 6.5 million family members and other carers.
Grainne Siggins is policy lead at the Association of Directors of Adult Social Services and Director of Adult Social Care at Newham Council.