The January Cabinet reshuffle saw Jeremy Hunt adding long-term care funding responsibility to his health portfolio and gaining a minister of state for health and social care. It was a market that, once again, government is trying to sort out issues that have confounded all parties for decades
This looks like a fresh start but it seems almost certain that any form of top-down approach to changes in social care, even assuming political will for change, will be stymied by lack of money.
Real-terms local authority adult social care budgets are falling, already down from £18 billion in 2009/10 to £16.5 billion in 2016/17, an 8% fall1. Demand is rising, courtesy of an aging population, with spending per head dropping 13.5% in England over the same period1. Then there’s a 700,000 shortfall in care workers expected by 2035. Set these figures in the context of plans for local authorities to be entirely self-funding through council tax and business rates by 2020 and the problem becomes clear.
Instead, initiatives need to come from the ground up, to make truly local social care more efficient and focused on individual needs. The aim will be to keep people healthier for longer and promote independent living, minimising the strain on nursing homes and hospitals. Above all, health care and social care must be joined up to provide the most efficient and effective services.
Currently, NHS England contributes £1.6 billion a year to local authorities’ social care budgets but NHS and local authority care information is held separately. We need to break down the silos.
One way is to integrate local health, social care and third sector resources in a single physical location, with interoperable data systems. As each provider holds confidential records, sharing will only be possible if citizens give their informed consent.
A trial in Manchester known as the Citizens Jury shows how this can work, with a representative sample of the population deciding what should be shared with whom. Manchester is also taking a lead by developing the first devolved NHS/local authority health and social care budget.
Another essential is to optimise the use of professional and volunteer carers so they can spend more time with clients. Mobile technologies can help here, enabling paperwork to be completed on the move and minimising time spent on admin. This concept is already working in a CGI project in Helsinki – see LINK.
Wearable technology (think Theresa May’s automatic blood sugar monitor as an example) can also be used to generate and send health data on individuals, with devices used to monitor anything from blood pressure and breathing rate to the use of the bed or the fridge (too much of one and not enough of the second can indicate a problem).
These monitors allow professionals to intervene at an appropriate and often earlier point than if a person is left alone until a crisis develops. Again, this helps to keep people out of hospital or to shorten their stay, freeing precious resources. It is already normal practice in Finland and we’ll shortly be announcing a trial project with a local authority in England.
Artificial intelligence (AI) is another a powerful tool with potential to improve health and social care. When perfected, AI will help diagnosticians determine more quickly and accurately what is wrong with their patients and how they can best be helped. AI will also help social care case officers to map appropriate care paths for their clients, greatly reducing the time needed to develop an achievable plan.
But it’s not just about using technology. We need cultural change to solve the health and care conundrum. In Britain, young and old, healthy and unhealthy tend to live in separate communities. That’s not the case in other societies, where people help each other, instead of expecting the state to step in.
To give greater social mingling a nudge, the 300,000 new homes planned ever year for the next few years could be specified as a mixed economy of people – local authorities could mandate this, just as they insist on a proportion of affordable homes in new developments. The young can then help the elderly and the healthy can help the unwell. Incentives, such as subsidised mortgages or reduced council tax, could be given to volunteers.
None of these measures will be easy to implement. Each will require strong, local champions, perhaps employing the principles that underpin the successes in Manchester. There will be trials, starting small. But success will breed success, as good schemes are copied.
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