It is early days for the new Government, but we are starting to learn about its initial approach to social care.
The Prime Minister has appointed her best political friend, Thérèse Coffey, as secretary of state for health and social care. This signals she recognises how politically salient the work of that department is.
Within a day of starting the job Ms Coffey made clear that her priorities include speeding up patient flow in hospitals by discharging more people faster when medically fit to leave, as well as improving access to primary care and NHS dentistry. ‘Care’ did feature in the ‘ABCD’ shorthand of what she wants to focus on. But perhaps there was less about social care in itself, more about how it works alongside the NHS within integrated local systems, particularly as regards hospital admissions and discharges.
Some have expressed disappointment that the new administration seems to be viewing social care in such narrow terms, but Liz Truss is a politician in a hurry: she has no more than about two years before a General Election and by then she has to neutralise the NHS as a gift for the opposition parties. This means, above all, ensuring there is a lot less public unhappiness about getting help from GPs than there is now, improved ambulance response times, and reduced elective waiting lists.
Visible progress is required quickly on all three, in part to build public and professional confidence before a deeply challenging winter.
The Prime Minister and her colleagues seem to appreciate that to improve ambulance response times requires speeding up patient flow and discharges, and you can’t do either unless social care is in a position to respond. As readers know, the problem of assembling suitable care packages, especially home care ones, is probably the biggest barrier, if not the only one.
So how best to do it? Ms Coffey is said to be considering paying care homes large sums to create more placements for discharged patients. However, this is problematic, because most of the people who need care following discharge require it in their own homes, not a care home. If they enter residential care when lower level support would be more appropriate, there is a risk they regain less fitness and capability and so require more care earlier than would otherwise be the case.
The current biggest problem in social care is the shortage of paid staff, so care homes won’t be able to create more places anyway unless they have enough people. Low pay within social care is a topic the previous Government didn’t seem to want to talk about, yet most experts agree that you cannot stabilise care without substantially improving wages.
Additional Government money for care training was welcome, but no substitute for addressing the fact care pay has been overtaken by that in hospitality, retail and the NHS in recent years. Bringing in staff from abroad helped to cover the cracks, but became a lot more challenging post-Brexit.
It seems to me the secretary of state’s first priority should be to arrest the continual decline in the social care workforce, by investing a lot more money into social care generally, and into care pay, in particular. Otherwise, for all her aspirations, the likelihood is the situation will get worse, not better.
We don’t yet know the Government’s intentions as regards the cap on care costs, but it needs to make some decisions quickly. It’s hard to see them reneging on their commitment to proceed. There is a question over funding the policy if the Prime Minister abolishes the National Insurance premium that was designed to pay for it. It is also widely agreed the set up and running costs were underfunded, so if the new Government wants to avoid an implementation car crash later on it would be wise to take another look at the resourcing now.
Caroline Abrahams CBE is charity director at Age UK
@Car_Abrahams @age_uk
