People who don’t get care support at home are nearly a third more likely to end up in hospital

• 61% of older people who do not get help with the basics visit hospital each year
• Experts from NHS Confederation, British Red Cross,  and Care and Support Alliance speak out
• Government must to address “chronic underfunding” in care system

The evidence that community care prevents people being isolated, falling into crisis and ending up in hospitals is now impossible to ignore, according to 75 organisations supporting older and vulnerable people, and family carers.

As MPs prepare to have their final debate on the Care Bill, the Care and Support Alliance, argue that getting care reform right is crucial to easing the growing pressure on our health system.

The CSA points to new analysis of the latest Health Survey for England. It says this is the “missing evidence” that backs up the succession of influential voices who have recently spoken out on the increasing numbers of older and disabled people reporting to hospitals, rather than community-based services.

Today two more voices speak out: the NHS Confederation – which represents all organisations that commission and provide NHS services – and the Red Cross, whose teams work in A&E to prevent or shorten hospital stays of people who are clinically fit but do need care and support at home.

Richard Hawkes, chair of the Care and Support Alliance, said:

“For the first time we can put a finger on the considerable impact local care support has on easing pressure on hard-pressed hospitals.

“This is the missing evidence that backs up a succession of experts speaking out on the issue.

“The winter A&E crisis is being intensified by an historic squeeze on council-funded local care.

“Chronic underfunding has left hundreds of thousands of older and disabled people, who need support to do the basics, like getting up or out of the house, cut out of the care system

“The impact is being felt throughout the health and care system.

“The Government has put forward strong proposals in its Care Bill, which will greatly improve a social care system which is on its knees.   But it’s becoming clear that a huge number of older and disabled people will not see any of the benefits of the new system, because of plans to tightly restrict who gets care.

“This will place huge pressure on family carers.

“We want the Government to have the courage to see its bold plans through, and make sure that those who need support to live independently get council care.

“To do this, the Government needs to commit to properly funding the social care system.”

Rob Webster, Chief Executive of the NHS Confederation, said:

“When people’s needs are not met by the social care system, they have nowhere to turn but the NHS. This means pressures in social care lead to pressures in the NHS and poorer quality care, with community services under pressure, delays in getting people home from hospital and problems at A&E

“A sustainable long-term funding settlement for social care that allows local authorities to spend money on all those who need care is crucial if the health and social care system as a whole is to be sustainable. We agree with the Care and Support Alliance that the objectives of social care reform and the Care Bill will not be met without sufficient funding.

“The health and social care system will struggle to meet people’s needs unless we can reshape care to be better co-ordinated and more community based, to prevent people reaching crisis point and to maintain their wellbeing for as long as possible.

“The NHS Confederation’s 2015 Challenge is calling for an honest national debate about how the NHS and care system needs to change if provision of care, free at the point of need, is to be sustainable.”

The British Red Cross staff and volunteers work in major A&Es to help people who turn to hospitals when they might be better served by support in the community.

Mike Adamson, Managing Director, British Red Cross, said:

“Elderly patients in particular often arrive in A&E as a first port of call, when there isn’t a significant clinical need but they feel unwell and this is compounded by their isolation. We know that A&E units sometimes admit these patients to the wards because staff are concerned about the patient’s vulnerability and because there is no support at home.

“Yet reaching a point where admission seems the only safe course of action is avoidable if the right support networks are in place.

“Our staff and volunteers support A&E units across the country by preventing admission to the acute wards. We help patients who would otherwise be admitted because of social need to safely return home or arrange care elsewhere.

“Ultimately, however, our services are a stop-gap and the system needs to be reformed so that people do not turn to hospitals due to a lack of support at home in the first place.””

Rachael Jones, Sister at Accident and Emergency Department Observation Ward Blackpool Victoria Hospital

“Many patients are admitted to A&E when their needs are more of a social care nature and linked to general ill health or the fragility of advanced age. This doesn’t mean they don’t have medical issues, but these could often be managed better in the community and studies back this up. A lack of support at home can bring about more admissions to the A&E department when people struggle to manage.

“Sometimes patients will be discharged because no further medical intervention is required but return a few days later because they are distressed, frightened or not coping well on their own.

“When the British Red Cross provide the Enhanced Discharge Service it gives the A&E medical staff peace of mind knowing they will make sure the patient is settled at home, be able to assess the home situation and carry out follow up work if needed. This also releases much needed beds in a busy environment for incoming patients.”

3. Influential voices speak who have recently spoken out on the link between care and A&E:

The Health Secretary Jeremy Hunt MP said: “If the NHS is going to be sustainable with an ageing population we need to be much, much better at looking after people out of hospital.”

Sir Bruce Keogh medical director of NHS England echoed those sentiments in his evidence to the Commons Health Committee, “… A&E is where the problem is manifest, but actually the problems lie in social care, they lie in primary care, they lie in communities…”

Health research and think-tank The King’s Fund sees community-based care as essential to reduce hospital admission rates, and stemming growing demand for hospital beds.

Last year Care Quality Commission head David Prior said emergency departments were ‘out of control’, and ‘Many frail elderly people who ended up in hospital should not be there’.

4. Funding squeeze

Cash-strapped councils are rationing care. The number of people receiving support has plummeted for five years in a row – by a total of 347,000 since 2008. Sitting behind the squeeze is the fact that councils have had to reduce their adult social care budgets by £2.6bn in the last three years alone, according to social services directors

5. Care Bill 

MPs are set to hold their final debate on the Care Bill, Monday 10^th March. The CSA has called the bill ‘a real achievement’ and praised a series of positive amendments to the Care Bill, including the right to an independent advocate for some of the most vulnerable people. However, outside of parliamentary debates, restricted access and funding remain issues.

6. Eligibility

The Government is planning to restrict the number of people who can benefit from the new system.

According to the London School of Economics, setting the threshold at ‘substantial’ means approximately 362,000 older and disabled people will not receive any support from their council. They will have to pay for their own care without their costs being capped.

Of the 152 councils in England, government figures (“Social Care Legal Reform IA”; 2.5 table 8) show 86% now offer care only to those with the highest level of needs – deemed as ‘critical’ or ‘substantial’ needs.

In those areas this means older and disabled people who are unable to undertake several aspects of personal care, or of work, education or training are no longer eligible for council-funded care.

Under the current system they are described as people with ‘moderate needs’. But the CSA argues that description doesn’t capture the significant impact not having support has on a person’s life.

The Care and Support Alliance is calling on the Government to set eligibility at ‘moderate’ so as many people as possible benefit from the new system, and get the preventative support that keeps them from falling into crisis and ending up in A&E.

The final decision on where the national threshold will be set will be published for consultation in spring 2014 year and voted on in autumn 2014.

7. Analysis of Health Survey for England  

The CSA analysed over 1,000 respondents to the Health Survey aged 65 and over who said they need help with activities of daily living (things like help getting washed, dressed, going to the toilet).

They examined if those same people had received any care and support at home, and cross referenced that if they have been to hospital in the past twelve months.

	Have you been to hospital in the last 12 months?
	Yes	No
People whose care needs are met	47.2%	52.8%
People with one or more unmet care needs	60.5%	39.5%
Total	51.1%	48.9%

 

 

Source: Health Survey for England (2011), baseline=1,166

The CSA have agreed the wording of an amendment with the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS) which will be the priority for all of the three groups at Report Stage of the Care Bill.  The Report Stage will be on 10th March. 

The amendment has been tabled by Paul Burstow – the former Care Minister – and seeks to create a reporting mechanism to make sure the care system is adequately funded and that those disabled and older people who need care,are able to access it. 

Paul is keen to prioritise this amendment and make as big an impact as possible.  We are working with him and our Parliamentary supporters to get as much political pressure behind the amendment as possible. 

This is a final chance as the Bill goes through Parliament to push the Government to make sure the Bill is adequately funded – the Care and Support Alliance will work together to make sure the amendment makes as big a splash as possible. The CSA have lined up joint media work with the LGA on the amendment itself. 

You can download the joint briefing on the amendment as well as the CSA briefing on the report stage here 

Sir John Oldham, a former Department of Health lead on quality and innovation, is publishing an independent report into Labour’s Whole Person Care proposals.

Commenting on the report, Richard Hawkes Chair of the Care and Support Alliance, said:

“Chronic underfunding has left older and disabled people who need support to get up or out of the house cut out of the care system.

“Without that support, people become isolated, slip into crisis and often end up in A&E.

“The impact is being felt throughout the health and care system.

“Looking properly at how to integrate health and care services must be part of a solution to the care crisis.

“Today’s report is an important milestone in what is one of the biggest challenges facing families up and down the country – will they get the care support they need?”

Today the Health Select Committee published their seventh report of Session 2013 – 2014, Public expenditure on health and social care. This report states a recommendation that the current level of real terms funding for social care should be ring-fenced.

The report states

““We also recommend, as we did a year ago, that the current level of real terms funding for social care should be ring-fenced. Alongside the Government’s commitment to maintain health spending at current levels in real terms, this would give certainty about budgets for a whole health and care economy and provide a firm financial basis for Health and Wellbeing Boards to plan and implement transformative service change”.

“Without stronger commissioners and ring-fenced health and care funding, we believe there is a serious risk to both the quality and availability of care services to vulnerable people in the years ahead”.

Commenting on the Health Select Committee report, Richard Hawkes, Chair of the Care and Support Alliance said:

“This is another powerful reminder that chronic underfunding has left the social care system on its knees. The impact is being felt throughout the health and care system.

“The Committee is right to stress that unless care funding is protected more vulnerable people will slip out of the system. This means more people struggling to get up, get washed, get dressed and get out of the house; more people becoming isolated, likely to slip into crisis and ending up in A&E.

“Up and down the country social care makes a huge difference to people’s lives.

“But councils are forced to ration care. Care providers say it’s becoming impossible to work on the ground. Ultimately older and disabled people are left without the support they need.

“The Minister has engaged with the sector and acknowledged the issue. The Government’s Care Bill reforms, which are set to be voted on this month, will make a big difference.

“But the plans must go hand-in-hand with a commitment to make sure that those who need support to live independently get community care and the investment is in place to make it happen.”

Today BBC released a news story showing most councils in England pay less than the recommended minimum for personal home care.

Data obtained under the Freedom of Information Act found only 4 in 101 cases showed providers being paid the minimum figure of £15.19 an hour, the minimum cost suggested by UKHCA. The average minimum rate paid by councils was found to be £12.26 an hour.

The figure of £15.19 is calculated by looking at the wages paid to the care worker, travel costs, training, agency fees, insurance and pensions. Trevor Broklebank, chief executive of Home Instead Senior Care in Salford, said “It’s impossible to deliver quality care for the hourly rate that’s been offered.”

The Care and Support Alliance have shown in recent analysis the squeeze on social care, and sitting behind the squeeze is the fact that councils have had to reduce their adult social care budgets by £2.6bn in the last three years alone, according to social services directors.

Richard Hawkes, Chair of the Care and Support Alliance said today;

“This is yet more proof that chronic underfunding has left the social care system on its knees.

“Up and down the country social care makes a huge difference to people’s lives.

“But councils are forced to ration care. Care providers say it’s becoming impossible to work on the ground. Ultimately older and disabled people are left without the support they need to get up, get washed, get dressed and get out of the house. Without that support they become isolated, more likely to slip into crisis and end up in A&E.

“The Minister has engaged with the sector and acknowledged the issue. The Government’s Care Bill reforms, which are set to be voted on this month, will make a big difference.

“But the plans must go hand-in-hand with a commitment to make sure that those who need support to live independently get community-based care and the investment to make it happen”

 

Today MPs debate the Government’s Care Reforms.

Former Care Minister Paul Burstow is fronting a cross-party bid to make sure more older and disabled people get local care.

Six MPs have now put their name to the eligibility amendment – making it the most backed, most cross-party amendment of the Care Bill.

Here’s the link to the amendment. It’s clause 13 on page 3.

It’s supported by the Care and Support Alliance, whose new analysis shows that community care is being squeezed. The Alliance links the findings to the pressure on A&E and calls for greater investment in social care.

Paul Burstow said: “Social care is the vital support that older and disabled people need to live independently and with dignity. The Care Bill is a landmark piece of legislation which has the potential to revolutionise a care system which is all too often failing to support some of the most vulnerable members of our society.

“The new national eligibility threshold will end the postcode lottery for care, however there is a danger that if this threshold is set too high, hundreds of thousands of older and disabled people will be denied the support they need to live fulfilling lives in their community.

“My amendment, urging the Government to invest in a threshold which supports individuals with lower level needs, will ensure they get the help they need to maintain independence.”