The challenges facing the adult social care sector have been mounting for years. The sector has been consistently underfunded despite rising demand for services at a time of significant staff shortages. Health services have succeeded in supporting people to live longer, which means the number of people with some form of care need is growing. To manage this increase, we need a well-functioning social care system that supports people to live flourishing lives in the place they call home. However, this is currently not the case.
In a recent interview for the NHS Providers podcast, Sir Andrew Dilnot, who chaired the Commission on Funding of Care and Support in 2010, discusses the "crisis" in social care that is both "failing to look after people that need social care and doing damage to the provision of health care". He says the current system is "unsustainable", with 152,000 vacancies across the sector, a precarious provider market, significant levels of unmet and under-met need, and individuals facing uncertain – and sometimes catastrophic – care costs. However, successive governments have ditched or delayed social care reform to the detriment of those who deliver and receive care, the economy and the wider health and care system. Sir Andrew argues that it is time for politicians to "face up" to the "desperate state" of social care.
This is what will likely happen if they don't.
The human aspect
Failing to confront the problems in social care means a continued failure to deliver the right care to all those who need it. In England, millions of people request some form of social care support each year. Some will be younger people and working age adults, groups that are often forgotten in the conversation around social care, but who can face unfair and burdensome care costs throughout their lives.
However, due to staff shortages and capacity constraints caused by underfunding, many people struggle to access care, or the right level of care, and are therefore left with under-met or unmet needs. For instance, almost half a million people are currently waiting for adult social care services, which can risk a deterioration of their health and wellbeing.
It's also important to remember that the failure to meaningfully reform social care has impacts that go far beyond the individuals receiving care. Limited social care provision places additional burden on the millions of people who dedicate their lives to caring for loved ones, with minimal support or recognition for the vital work they do as an unpaid carer. Although many carers derive a great sense of satisfaction and pride from their roles, it can significantly impact their ability to pursue paid work and can impact their mental health and wellbeing.
Ignoring social care reform also means continuing to undervalue 1.5 million people who work incredibly hard, often with very poor pay and conditions, to enable people to live rewarding and fulfilling lives.
The wider health and care system
A failure to meaningfully confront challenges facing the social care sector also has significant consequences for the wider health system: they are two sides of the same coin.
An under-resourced social care sector means too many people are going without the vital support they need to stay well in the community, to the detriment of their health. This impacts providers in the health service by increasing the risk of hospital admissions and readmissions, making it harder for people to move seamlessly between health and social care services.
The impact of this can be seen right across the NHS. Pressures on ambulance services, handover delays and delayed discharges all remain stubbornly high. At the end of November 2023, there were 7.61 million people waiting for planned treatments and operations. While NHS leaders are working incredibly hard to bring this down, a well-resourced social care sector is a key piece in the puzzle.
The economy
Failure to put social care on a sustainable footing also overlooks the economic value that investment could bring. In 2020/21, the gross value added (GVA) of adult social care, which measures the increase in the value of the economy due to the production of goods and services, was £25.6bn (1.6% of total GVA for England).
Social care should therefore be seen as an investment rather than a cost. According to analysis by the Future Social Care Coalition, economic inactivity is one of the biggest problems facing the UK, and is driven predominantly by 50–64-year-olds who are either unpaid carers or suffering from long-term sickness or disability. Investing in the social care sector could help unlock the labour market by supporting people to stay in paid employment, promoting financial independence and reducing the burden on the welfare system.
Time to be honest
The neglect of social care has had myriad social and economic consequences. But most of all there is a human cost. Social care is not just about keeping people alive, it is about allowing people to continue to flourish and live fulfilling lives.
On the NHS Providers podcast Sir Andrew Dilnot calls on decision-makers to "grow up", "be honest", and "don't pretend it's not going on". While tackling this situation might be a daunting task for any government, it is an inescapable problem, and one that is inextricably linked to creating an effective and sustainable health and care system for the future. It would be prudent for politicians of all parties to recognise this sooner rather than later: it is time to address the elephant in the room.
This opinion piece was first published by Public Sector Focus.
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