Briefing for peers ahead of debate on winter pressures

Reduction in adult social care support

Due to financial pressures the availability of adult social care packages has reduced. 90 percent of councils are now only able to respond to people with critical and substantial needs. In 2005 it was 47 percent. At least 400,000 fewer people are getting publicly funded help. There are urgent questions about how we manage the growing gap between needs, resources, and expectations, which is estimated to reach £2.3 billion by 2020. This is against a back drop of increasing demographic pressures and increasing demand for services. Demography is the biggest single pressure, requiring an additional 3% per year to maintain services at their current level.[1] As fewer people are receiving social care support, they might end up going to A&E/hospital as the default option when other support services would often be more appropriate.

Avoiding hospital admissions

There is huge potential for adult social care to offer people seamless, community based and person-centred services to improve their health and wellbeing outcomes. In many areas, community and social care services, often organised around GP practices/community health centres, are working together to avoid hospital admissions and ensure safe discharge from hospital, particularly for people with long-term conditions.

Supporting people to manage their own health conditions can reduce the need for hospital admission. The evidence is clear that offering people rehabilitation and re-enablement after illness enables them to return to independent living and avoids the need for long term care. However, all too often the care and health system is better at reacting to crisis and relies too much on hospitals and long term care. This fuels a vicious circle of escalating demand met through the most costly systems.

Pressure on urgent and emergency care

Pressure continues to increase in hospitals. For example, over the last five years delayed transfer of care has risen, however due to the hard work of the locally challenged systems the last few months have seen a reduction. The latest figures, for November 2017, show the number of delayed days for social care has decrease by 21.4 compared to November 2016. The reduction in delayed transfer of care is unlikely to have been achieved, without the additional £2 billion provided in the 2017 Spring Budget through the Improved Better Care Fund. The main reason for social care delays was patients awaiting care package in their own home. This accounted for 35.4% of all social care delays.[2] The challenge of care packages hasn’t been helped by hospitals purchasing their own care packages. This doesn’t help reduce demand, but results in higher fees being paid to the providers. A more co-ordinated approach to care packages is needed.   The evidence clearly shows the significant challenge of putting together packages of care in a timely fashion to enable people to avoid hospital admission in the first place or to be supported home once fit enough after admission.

Councils have been engaged in a range of activities to help combat delayed transfers of care, such as through six and seven day working, reallocating social work capacity to hospitals to support discharge nurses, increasing reablement support services, commissioning additional ‘step-down’ care home beds to get people out of hospital, and purchasing additional home care capacity.

When local areas have invested in social care and primary service infrastructure, it has helped shape joined up services and reduced pressure in acute hospitals. However, there is a clear pattern over a number of years that resources end up in the hospital system as people end up there when other forms of care are more appropriate.

Without investment in community and social care services the circle will continue. The never ending demands placed on hospitals often results in a lack of investment in other services. This means that new funding goes to address the pressures rather than the problem. The Government needs to tackle the causes of the pressures on hospitals by providing sufficient funding for social care. This will make better use of resources by prevention or early intervention.

Workforce

None of this can be achieved without a stable, supported, and skilled workforce. Our experiences tell us that a well led, well trained workforce provides effective, high quality, person-centred care and support. This means people accessing care and support can be independent and lead healthy lives, minimising demand on the NHS. However, there are a number of workforce challenges which make this difficult. [3] The overall staff vacancy rate across the whole of the care sector has increased from 4.5% in 2012/13 to 6.8% in 2015/16. These difficulties relate in part to the relatively low level of wages in a sector that is large – over 1.5 million jobs – and projected to grow by between 15 and 55% between 2013 and 2025 as the volume of care needs rise. This situation isn’t helped by the fact that health and social care are often chasing the same staff, such as nurses in nursing homes. Despite the significant challenges over winter of a failing care market and insufficient care homes, the social care workforce continue to provide dedicated care to vulnerable, older and disabled people.

The average wage of a care worker is £15,007 and the mean hourly rate for care workers in the independent sector in 2016 was £7.72, just £0.52 above the national living wage at the time. Another major threat to workforce sustainability arises from Brexit and potential changes to immigration policy. Around one in 20 (6%) of England’s growing social care workforce are non-British European Economic Area nationals – around 84,000 people.

Delays of elective surgery

Waiting for elective surgery involves a prolonged period of decreased health and an affected psychological and social life of the patient in waiting. It is bad enough for someone who is waiting for surgery, but especially for someone who is waiting for a hip operation or cataracts removal when it can impact on their life in a serious way. Not only will this impact upon the individual, but other non-hospital services, such as adult social are. If people aren’t able to have elective surgery, then they will have continuing support needs which creates further pressures on already stretched local authority budgets.

[1] ADASS, DVP, March 2017

[2] NHSE, Figures published 11 January 2018

[3] Skills for Care - The state of the adult social care sector and workforce in England 2017, September 2017