>The National Health Service (NHS) in England is under unprecedented strain. So it is baffling that more than one in ten of its beds are occupied by patients who do not need them. Some 13,600 inpatients are medically ready to be discharged yet remain in hospital—more than double the number five years ago. This is bad for them, as unnecessary stays tend to weaken patients and increase their susceptibility to infection. It is even worse for the sick people waiting outside in ambulances, queuing in record numbers to get in.
>Discharging a patient requires a dizzying amount of administrative work, with doctors, social workers and managers all having to sign off. Much of this bureaucracy is still done on paper. “It is easier to track a pizza than it is our patients across health and social care,” says John O’Connell, who is leading an NHS pilot scheme to digitise the discharge process. One problem, however, cannot be solved by technology. Increasingly, when patients are ready to leave, there are no carers available to look after them.
>In 2021 the number of workers in adult social care fell by 50,000, the first decline in the decade that there have been records. There are 165,000 vacancies; one in 11 posts is unfilled. As the workforce dwindles, so does the quantity and quality of care on offer. The proportion of older people receiving state-supported long-term care is decreasing, but this does not seem to be because their needs are diminishing. Public satisfaction with social care, always lower than with the NHS, fell from 29% three years ago to a dismal 15% in 2021.
>Frustration stems in part from a complicated system. Long-term social care, consisting of both in-home care and care in nursing and residential homes, is supplied by thousands of mostly private providers. It is difficult to get publicly funded care. In order to qualify, a person must typically be deemed by their local authority to have both high needs and assets of less than £23,250 ($28,100). Separate funding streams hobble efforts to integrate the NHS and the social-care system: money for social care is still primarily funnelled to local authorities through the Department for Levelling Up, Housing and Communities, not the Department of Health.
>More fundamentally, in the decade from 2010 the funding of local authorities fell by half in real terms. Some losses were made up by rises in local council tax and by the introduction of a special social-care “precept”, or levy. But in 2020-21 prices, social-care spending still fell from £514 per adult citizen in 2010-11 to £478 per adult citizen ten years later.
>Josh Hawker of AbleCare Homes, which runs six care homes in the south-west, says his firm needs £800-1,000 per week to look after a client. That seems cheap given that it costs the NHS at least £2,500 per week to keep someone in hospital. But Mr Hawker says that Bristol city council pays £771 for each state-funded client, almost irrespective of their needs. The “council just aren’t paying what it costs to look after people”, he says. Self-funders, who make up the remaining third of residents, end up paying more to subsidise others.
>The miserliness exerts downward pressure on wages. At £9.50, the median hourly wage of a care worker is less than that for an easier job stacking shelves at a supermarket. One of Mr Hawker’s employees had been an “excellent” care worker for a decade, he says. But when she quit to start an entry-level job as an administrator in the NHS, she instantly received a pay bump of 30%. When they are unable to find replacements, some providers fill the gaps with exorbitantly priced agency staff. Others make do with a smaller workforce.
>The losers are society’s elderly and most vulnerable. Age UK, a charity, estimates that around 2.6m adults who need some kind of care are not receiving it. In the first three months of 2022, 2.2m hours of home care could not be delivered because of a shortage of staff. Providers such as Right at Home, a home-care franchise, are increasingly focusing on self-funding clients. “It means we can pay our workers more,” says Lucy Campbell, the CEO. Those who cannot afford such services may have to go without, or rely on unpaid carers instead.
>Care homes must contend with soaring energy costs as well as worker shortfalls. That means making tough choices. At best, carpets grow shabbier and walls aren’t repainted. At worst, clients with more complex (ie, costlier) needs are turned away. Profit margins are at their lowest since the Care Quality Commission, a regulator, began monitoring them in 2015. “You’d be mad to open a care home at the moment,” says Mr Hawker.
>The autumn statement on November 17th did bring some relief. Jeremy Hunt, the chancellor of the exchequer, pledged up to £7.5bn of extra money for social care over two years, a chunk of which will come from allowing local authorities to raise council tax. Around a third of the money is tied to hospital discharges, to be split with the NHS; some of the rest will probably go on wages.
>Mr Hunt described the cash as “the biggest increase [in social-care funding] under any government of any colour in history”. But the money fell short of his own assessment of what was needed when he chaired the health and social-care select committee: in December 2021 he said that fixing social care would require an extra £7bn a year.
>To many within the sector, the injection of cash amounts to mouth-to-mouth resuscitation, not a coherent treatment plan. “These are tiny sums of money given the issues,” says Geoff Butcher, who runs Blackadder care homes in the West Midlands. “I honestly cannot see them addressing the problem.” Clive Lewis, the leader of Wokingham council, in the south-east, agrees. To save money for social care, he is still considering reducing the bin collection from weekly to fortnightly. He is already relocating council employees in order to rent out the top two floors of their offices.
>The additional funds have meant delays to long-term reform. Some of the extra cash has been found by deferring a plan to cap the lifetime costs of personal care paid by individuals in England at £86,000 (a policy that Mr Hunt himself had backed). Councils say that the cap could never have been implemented by October 2023, as originally planned. Others (including the plan’s architect, Sir Andrew Dilnot) feel that the suspension is short-sighted: the introduction of a cap would not lead to increases in public spending immediately but would bring peace of mind to many families. Around one in seven over-65s face bills of more than £100,000 for their own care. The government is trying to plug holes in social-care provision but “the public wants more than that,” says Simon Bottery of The King’s Fund, a think-tank. “They want a better, fairer system.”
While some of this is fair enough, the underlying message is wrong.
It would be disastrous to merge social care with health, utterly completely disastrous. The medical model does not complement the social model of care in the manner that would allow this to occur without serious detriment to the provision of social care.
Care homes wouldn’t need that amount of money per week, per person if it wasn’t for the fact they seek profit, huge profit. That’s why hedge fund managers have invested in our care homes.
The lack of funding is glaringly purposeful. Central government wants to fuck social care so it can gut it and either sell it or add it to the ever growing undercover privatisation of health care.
Social care is fucked. Hundreds of committed social workers and social care workers try hard to get people the care they need. But their upper managers are far too involved in the politics of local government to remember their social care ethics.
It’s not difficult to get into a care home if they are available, it is difficult to get the Care Act right of choice though. Yes you do have to pay if you own over 23k in savings, but that’s a fair amount of money tbh. You needn’t lose your house over it if you’ve taken advice prior to being care, which you should do btw, ask about trusts and social care. Also your house is safe if your partner lives there or for a variety of other reasons.
Don’t let the government fuck up social care any more than it already has.
Private care homes cost so much because the off shore hedge funds that bought them last decade sold the buildings to a holding company, pocketed the cash and left the home paying rent.
That said, local authorities don’t pay enough for people who qualify for support, homes don’t pay enough to their workers, and there just aren’t enough care workers to go round. And then when you can take someone from hospital it can takes weeks to get it sorted as the NHS and the council argue about who should pay, and you wait for over-worked and under-staffed departments to complete their assessments. Frequently for it to then turn out that they need facilities you don’t have and you end up having to turn them down in the end and it all starts off again.
Cutting the councils out of the circuit and replacing them with a National Care Service akin to the NHS would be the sensible solution – but this ain’t 1946 sadly.
Social care has been strangled since Cameron became PM, Children’s services, Social Services are a complete joke, management have no interest in best outcomes and just tick box jobs to a very low standard, special needs service users are left wandering around our town centre, The Police are used as first point of contact and sent to handle Mental Health crisis intervention situations, hospitals are used to house people who should be recuperating at home but can’t as there’s no Care staff available. Brexit has seen Care Staff go home, from an already depleted/demoralised, underpaid,underappreciated, workforce. Most people don’t care because it doesn’t affect them, thank you David Cameron and the Conservative Party.
Good. You get what you vote for.
Shame we don’t have Euthanasia / Assisted Dying to fix this issue… but again, they vote for the anti-liberal party
5 comments
>The National Health Service (NHS) in England is under unprecedented strain. So it is baffling that more than one in ten of its beds are occupied by patients who do not need them. Some 13,600 inpatients are medically ready to be discharged yet remain in hospital—more than double the number five years ago. This is bad for them, as unnecessary stays tend to weaken patients and increase their susceptibility to infection. It is even worse for the sick people waiting outside in ambulances, queuing in record numbers to get in.
>Discharging a patient requires a dizzying amount of administrative work, with doctors, social workers and managers all having to sign off. Much of this bureaucracy is still done on paper. “It is easier to track a pizza than it is our patients across health and social care,” says John O’Connell, who is leading an NHS pilot scheme to digitise the discharge process. One problem, however, cannot be solved by technology. Increasingly, when patients are ready to leave, there are no carers available to look after them.
>In 2021 the number of workers in adult social care fell by 50,000, the first decline in the decade that there have been records. There are 165,000 vacancies; one in 11 posts is unfilled. As the workforce dwindles, so does the quantity and quality of care on offer. The proportion of older people receiving state-supported long-term care is decreasing, but this does not seem to be because their needs are diminishing. Public satisfaction with social care, always lower than with the NHS, fell from 29% three years ago to a dismal 15% in 2021.
>Frustration stems in part from a complicated system. Long-term social care, consisting of both in-home care and care in nursing and residential homes, is supplied by thousands of mostly private providers. It is difficult to get publicly funded care. In order to qualify, a person must typically be deemed by their local authority to have both high needs and assets of less than £23,250 ($28,100). Separate funding streams hobble efforts to integrate the NHS and the social-care system: money for social care is still primarily funnelled to local authorities through the Department for Levelling Up, Housing and Communities, not the Department of Health.
>More fundamentally, in the decade from 2010 the funding of local authorities fell by half in real terms. Some losses were made up by rises in local council tax and by the introduction of a special social-care “precept”, or levy. But in 2020-21 prices, social-care spending still fell from £514 per adult citizen in 2010-11 to £478 per adult citizen ten years later.
>Josh Hawker of AbleCare Homes, which runs six care homes in the south-west, says his firm needs £800-1,000 per week to look after a client. That seems cheap given that it costs the NHS at least £2,500 per week to keep someone in hospital. But Mr Hawker says that Bristol city council pays £771 for each state-funded client, almost irrespective of their needs. The “council just aren’t paying what it costs to look after people”, he says. Self-funders, who make up the remaining third of residents, end up paying more to subsidise others.
>The miserliness exerts downward pressure on wages. At £9.50, the median hourly wage of a care worker is less than that for an easier job stacking shelves at a supermarket. One of Mr Hawker’s employees had been an “excellent” care worker for a decade, he says. But when she quit to start an entry-level job as an administrator in the NHS, she instantly received a pay bump of 30%. When they are unable to find replacements, some providers fill the gaps with exorbitantly priced agency staff. Others make do with a smaller workforce.
>The losers are society’s elderly and most vulnerable. Age UK, a charity, estimates that around 2.6m adults who need some kind of care are not receiving it. In the first three months of 2022, 2.2m hours of home care could not be delivered because of a shortage of staff. Providers such as Right at Home, a home-care franchise, are increasingly focusing on self-funding clients. “It means we can pay our workers more,” says Lucy Campbell, the CEO. Those who cannot afford such services may have to go without, or rely on unpaid carers instead.
>Care homes must contend with soaring energy costs as well as worker shortfalls. That means making tough choices. At best, carpets grow shabbier and walls aren’t repainted. At worst, clients with more complex (ie, costlier) needs are turned away. Profit margins are at their lowest since the Care Quality Commission, a regulator, began monitoring them in 2015. “You’d be mad to open a care home at the moment,” says Mr Hawker.
>The autumn statement on November 17th did bring some relief. Jeremy Hunt, the chancellor of the exchequer, pledged up to £7.5bn of extra money for social care over two years, a chunk of which will come from allowing local authorities to raise council tax. Around a third of the money is tied to hospital discharges, to be split with the NHS; some of the rest will probably go on wages.
>Mr Hunt described the cash as “the biggest increase [in social-care funding] under any government of any colour in history”. But the money fell short of his own assessment of what was needed when he chaired the health and social-care select committee: in December 2021 he said that fixing social care would require an extra £7bn a year.
>To many within the sector, the injection of cash amounts to mouth-to-mouth resuscitation, not a coherent treatment plan. “These are tiny sums of money given the issues,” says Geoff Butcher, who runs Blackadder care homes in the West Midlands. “I honestly cannot see them addressing the problem.” Clive Lewis, the leader of Wokingham council, in the south-east, agrees. To save money for social care, he is still considering reducing the bin collection from weekly to fortnightly. He is already relocating council employees in order to rent out the top two floors of their offices.
>The additional funds have meant delays to long-term reform. Some of the extra cash has been found by deferring a plan to cap the lifetime costs of personal care paid by individuals in England at £86,000 (a policy that Mr Hunt himself had backed). Councils say that the cap could never have been implemented by October 2023, as originally planned. Others (including the plan’s architect, Sir Andrew Dilnot) feel that the suspension is short-sighted: the introduction of a cap would not lead to increases in public spending immediately but would bring peace of mind to many families. Around one in seven over-65s face bills of more than £100,000 for their own care. The government is trying to plug holes in social-care provision but “the public wants more than that,” says Simon Bottery of The King’s Fund, a think-tank. “They want a better, fairer system.”
While some of this is fair enough, the underlying message is wrong.
It would be disastrous to merge social care with health, utterly completely disastrous. The medical model does not complement the social model of care in the manner that would allow this to occur without serious detriment to the provision of social care.
Care homes wouldn’t need that amount of money per week, per person if it wasn’t for the fact they seek profit, huge profit. That’s why hedge fund managers have invested in our care homes.
The lack of funding is glaringly purposeful. Central government wants to fuck social care so it can gut it and either sell it or add it to the ever growing undercover privatisation of health care.
Social care is fucked. Hundreds of committed social workers and social care workers try hard to get people the care they need. But their upper managers are far too involved in the politics of local government to remember their social care ethics.
It’s not difficult to get into a care home if they are available, it is difficult to get the Care Act right of choice though. Yes you do have to pay if you own over 23k in savings, but that’s a fair amount of money tbh. You needn’t lose your house over it if you’ve taken advice prior to being care, which you should do btw, ask about trusts and social care. Also your house is safe if your partner lives there or for a variety of other reasons.
Don’t let the government fuck up social care any more than it already has.
Private care homes cost so much because the off shore hedge funds that bought them last decade sold the buildings to a holding company, pocketed the cash and left the home paying rent.
That said, local authorities don’t pay enough for people who qualify for support, homes don’t pay enough to their workers, and there just aren’t enough care workers to go round. And then when you can take someone from hospital it can takes weeks to get it sorted as the NHS and the council argue about who should pay, and you wait for over-worked and under-staffed departments to complete their assessments. Frequently for it to then turn out that they need facilities you don’t have and you end up having to turn them down in the end and it all starts off again.
Cutting the councils out of the circuit and replacing them with a National Care Service akin to the NHS would be the sensible solution – but this ain’t 1946 sadly.
Social care has been strangled since Cameron became PM, Children’s services, Social Services are a complete joke, management have no interest in best outcomes and just tick box jobs to a very low standard, special needs service users are left wandering around our town centre, The Police are used as first point of contact and sent to handle Mental Health crisis intervention situations, hospitals are used to house people who should be recuperating at home but can’t as there’s no Care staff available. Brexit has seen Care Staff go home, from an already depleted/demoralised, underpaid,underappreciated, workforce. Most people don’t care because it doesn’t affect them, thank you David Cameron and the Conservative Party.
Good. You get what you vote for.
Shame we don’t have Euthanasia / Assisted Dying to fix this issue… but again, they vote for the anti-liberal party