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I've watched the deterioration of the NHS at first hand. Trust me when I say as a political reporter, this is our country's biggest issue

With a 95-year-old mother-in-law and 93-year-old mum in a nursing and residential home respectively, I’ve seen up close the problems caused by the lack of a joined-up health and social care system for the past five years

Andrew Grice
Thursday 05 July 2018 10:53 BST
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NHS at 70: A timeline of the National Health Service and its crisis

An elderly woman, taken to hospital after a fall at her home one Friday, was ready to return home the next morning, but couldn’t be discharged because staff were not available over the weekend. On Monday, she couldn’t leave because her home care support was no longer available. After more than a month in hospital, her condition got worse and she went into residential care. She never saw her own home again.

The story, told in a study by the Care Quality Commission (CQC) regulator, is replicated daily. With a 95-year-old mother-in-law and 93-year-old mum in a nursing and residential home respectively, I’ve seen up close the problems caused by the lack of a joined-up health and social care system for the past five years.

Although hospitals are full and delayed discharges cost the NHS about £3bn a year, being released – even back into a care home – is often a slow and bureaucratic process. Last month I saw one resident go into hospital for “one day”; she stayed for three weeks. It would make sense for nursing homes to be able to administer drugs intravenously, since many residents go into hospital for chest and urinary infections that could be managed without the upheaval and cost of a hospital stay – and the risk of the dreaded secondary infection.

Social care, funded by local authorities, is collapsing. The overwhelming majority of the staff I come across are dedicated. But the constant pressure to cut costs, after councils had their government grants reduced by 49 per cent since 2010, means standards deteriorate. Staff-to-resident ratios are dangerously thin at times. Carers, working 12-hour shifts, are often paid the minimum wage and change jobs repeatedly. I’ve seen some have to resign to take a two-week holiday to visit family abroad, returning afterwards to the same job. The widespread use of agency workers mean that building relationships with residents is difficult.

The picture is confirmed by three official reports published yesterday and today. The CQC found examples of health and care services working well together, but too much ineffective coordination and fragmented care. Funding, commissioning, performance management and regulation encouraged organisations to focus on their individual performance rather than positive outcomes for people. Sir David Behan, the CQC’s chief executive, said cooperation is “often despite the conditions in place to facilitate joint working, rather than because of them. We need incentives that drive local leaders to work together, rather than push them apart.”

Thousands march to mark the NHS' 70th birthday

The Public Accounts Committee found that more than 80 per cent of local authorities overspent their social care budgets in 2016-17; two-thirds ate into their reserve funds, which are running out. The share of council budgets spent on social care has risen from 45 per cent to 54 per cent since 2010, putting huge pressure on other services.

Closer working between health and care has been discussed since 1974. No wonder the National Audit Office (NAO) public spending watchdog called for “further and faster progress towards a service that centres on the needs of individuals”. It warned that short-term funding arrangements and uncertainty about future funding make it more difficult for health and care services to plan effectively. (The £20bn-a-year boost for the NHS to mark its 70th birthday tomorrow, while welcome, risks becoming more of a sticking plaster, and noticeably included no money for social care.)

The silo mentality continues. Sir Amyas Morse, the NAO’s head, said: “The NHS did not like funds being syphoned off through the Better Care fund, while local government has reservations about sacrificing over half of its financial resources towards NHS England’s priorities, which risks eroding local democracy. The answer may lie in local flexibility, but that could leave serious gaps in delivering what is needed – an integrated service. Serious political leadership is needed.”

Over to you, Theresa May. But we shouldn’t hold our breath. Jeremy Hunt’s green paper on social care was due before parliament’s summer break but has been delayed until the autumn. The word in Whitehall is that it will contain another “menu of options” rather than firm proposals. MPs in all parties are starting to think radical thoughts, with some senior Tories even preparing to call for social care to be removed from local authorities. A bit socialist, perhaps, and not very local.

What a shame May so mishandled the launch of her plans to reform social care funding last year’s general election. If she had prepared the ground, and included a ceiling for an individual’s contribution towards their care costs from the start, she had the seeds of a good policy. But having had her fingers burnt by the “dementia tax” label, she seems reluctant to go there again.

May has asked Conservatives to come up with 1,000 policy ideas for their next manifesto. What the country needs is one big idea – on social care and the NHS. May needs it too; it might just show there is life (for her) after Brexit.

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