Time for a social care system refresh

By Paul Marinko | 18 January 2023

The thorny issue of social care reform was the topic for the round table on the fringes of The MJ’s Future Forum North event in Manchester.

With the faint background noise of the Dilnot reforms being kicked down the road and the deafening din of stop-gap care home places being snapped up by the NHS, the contrasting mood music around the table was a frankly depressing tune filled with messages of immediate need and ever-stretching demand and pressures.

Lyrics ringing out during this lunch hosted by The MJ and the National Audit Office (NAO) included workforce pressures, funding concerns and the strained relationship between social care and the NHS. Although, there were a few happier bars reserved for the potential of innovation and technology.

One participant opened with concerns over the ‘massive issue’ of an available workforce. Staff who are ‘not fully valued and appreciated’ are continuing to jump ship for the better pay available in other sectors.

‘My worry is whether we have any workforce to keep homes open and to deal with discharges,’ they ventured ominously.

‘The Government needs to recognise the value of the front line for the benefit it can bring to the whole system.’

The fundamental problem was expressed in simple terms – replacement staff are not being recruited as fast as they are leaving.

For many there was an eagerness to move away from a model of weak pay for such a vital pool of staff. The importance of attracting young, ambitious recruits into these roles is a particular ambition, but the day-to-day pressures and inadequacies of funding are starving the sector of the opportunity to address this.

‘We don’t have a proper workforce strategy that is about up-skilling and development,’ another stated.

A further headache expressed was the threat of losing even more capacity with the spectre of Care Quality Commission (CQC) inspections for social care – although these have at least been delayed until later this year.

‘They are going to recruit [for inspections] from the sector,’ pointed out one participant. ‘So, they are taking capacity out of the system to service this.’

The delay, though undoubtedly welcome, will do little to quell frustration at inspections during such pressure on social care.

‘The CQC are just going to spend millions on this and to what end?’ asked one chief executive.

Mention of money inevitably raised the temperature in the room, with funding unsurprisingly identified as a key issue at the heart of the social care crisis facing councils.

‘We also need proper funding,’ demanded a participant. ‘Not just more [opportunity to raise] council tax.

But another was ‘relieved’ the Government had put ‘some money into the system’ via the Autumn Statement because it provided some ‘stability’.

Highlighting the frustration at ministers’ continued prevarication and failure to take effective action, they added: ‘It’s about the “now” pressures. The system is on the verge of falling over.’

A live worry is that the delay, or possible failure, to implement the Dilnot reforms has robbed local government of the opportunity to get ready for the changes.

‘The deferral of the reforms has created uncertainty,’ said one voice. ‘Are they coming or not?’

‘We need the two years to prepare, but we are not going to get it.’

Another chimed in with: ‘If we spend the next two years only looking at the here and now we will have missed an opportunity.’

However, a further participant had ‘no confidence’ that the sector could do anything in this area in the next 24 months because councils are focused on ‘just keeping the wheels spinning’.

Despite councils up and down the country collaborating with colleagues in the health sector, the mention of the NHS often left a sour taste in the mouths of the lunchtime debaters.

‘The focus should not be on how social care supports the NHS,’ said one. ‘It’s not about that.’

Such a focus only went to show that ‘we have lost the plot as a nation’.

‘It’s about new models of care and moving away from the care home system.’

Another argued that 85 years after the Beveridge reforms the NHS was now designed for a different time.

‘We need to look at that. It needs to be put on the table, otherwise we will just tiptoe around it.

‘It was not designed for chronic need and policy-makers need to get their heads around it.’

To say there was a heavy note of scepticism at the NHS’s claim that delayed discharges from hospital were the result of blockages in the social care system would be to put it mildly.

‘Ninety-five per cent of the beds are not to do with social care,’ came one claim. ‘It’s not social care, it’s the inadequacies of the system.

‘It’s too easy for the NHS to say, “it’s them”.’

As one chief wryly pointed out, hospitals used to collect data on delayed discharges and it showed that two-thirds of the issue was down to them. Now they do not collect the data.

Another agreed, highlighting that it was widely recognised that a key driver for the health sector collecting data in this area was ‘to make social care look bad’.

The sclerotic state of the system was a huge frustration for participants, with one bemoaning that around 96% of their reablement team’s time was spent on discharges rather than genuine reablement.

‘We need to look at what needs to change in systems, processes and culture, both in adult social care and in the NHS,’ said one chief. ‘I don’t think we have dug down into that.’

Another emphasised the importance of showcasing what prevention had delivered. However, they added: ‘But the challenge with that is that we have been successful in a peripheral sense.’

There was real frustration that the issue of hospital discharges has dominated the entire debate.

‘The whole conversation about prevention has gone nowhere,’ said one voice.

The lunch finished with a positive note being struck. All agreed that innovation and technology was the good news in the world of modern social care.

‘Technological developments are where the positivity is,’ one participant claimed.

‘There is a good news story and we should be pushing it relentlessly.’

But there was consensus that technological innovations need to be grounded in what they actually achieved for the person receiving care support.

Nonetheless, there was also a recognition that the sector did not have the capacity and capability in the current climate to make the most of technology and innovation.

One suggestion thrown on the table was the possibility of Whitehall offering up some of its capacity – maybe in the shape of a few pilots – so the system could benefit as a whole.

A real appetite not to miss opportunities to harness tech was clear. One participant pointed to the benefits it had brought to Japan’s social care system – an approach they were keen for the UK to emulate.

However, there was a recognition that transformation wasn’t the main problem.

‘The real conundrum in this is not about transformation,’ said another participant around the table. ‘It’s the rise in demand that can’t be addressed. It’s the real rise in demand and real underfunding in the face of population growth.

Another agreed, saying the country was ‘nowhere near the financial model needed’.

So, not the rosiest of pictures painted. At least the debate was good…

The MJ/NAO round table participants

Harry Catherall, chief executive – Oldham MBC

Kate Josephs, chief executive – Sheffield City Council

Joanna Lewis, audit manager, value for money – National Audit Office

Ashley McDougall, director, local service delivery, value for money – National Audit Office

Kath O’Dwyer, chief executive – St Helens MBC

Steve Rumbelow, chief executive – Rochdale MBC

Pam Smith, chief executive – Newcastle City Council

Tom Stannard, chief executive – Salford City Council

Jonathan Tew, chief executive – South Tyneside MBC

John Tradewell, deputy chief executive and director for corporate services – Staffordshire CC

Jonathan Werran, chief executive – Localis

Chair: Heather Jameson, editor – The MJ

Reporter: Paul Marinko – The MJ

This article is sponsored content for The MJ

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