Joined-up care: The elephant in the room

Elephant in room Image copyright Thinkstock

Encouraging greater integration between the NHS and social care systems - as the government has set out on Thursday - is like motherhood and apple pie. No-one would argue against it.

The line where NHS-funded healthcare ends and council-funded social care begins has always been blurred and failings on one side undoubtedly have an impact on the other.

So the idea of getting social care workers to join up with health staff, such as district nurses, physios and occupational therapists, to provide seven-day-a-week support in England has been widely welcomed.

In fact, some of the more innovative areas have been pioneering it for a while. What the government's £5.3bn Better Care Fund is doing is focusing national attention on the issue and (probably) helping to accelerate it.

That is good news for the vulnerable patients - many of them elderly - who benefit from this sort of help to keep them living independently in their own homes and out of hospital and care homes.

Funding shortfall

But there is an elephant in the room that no-one in government wants to talk about in much detail. It's the funding situation.

A popular saying in the sector is that "combining two leaky buckets does not create a watertight solution". The phrase was used by NHS England chief executive Simon Stevens in his first speech after he started in post in April.

It refers to the fact that both health and care are facing a tricky financial future. The £30bn funding gap predicted for the health service has been much discussed - only last week NHS England was setting out how it could be bridged.

But social care is also facing its own funding shortfall. A report published earlier this week by the Local Government Association and Association of Directors of Adult Social Services put it at £4.3bn. That may not sound much compared to what the health service is facing, but in terms of the overall budget it is a similar proportion.

A tale of two systems
NHS Social care
Services: Hospitals, GPs, mental health care and ambulance crews Services: Care homes, domiciliary care at home and day centres
Budget: £100bn Budget: £17bn
Funding shortfall: £30bn by 2020, according to NHS England Funding shortfall: £4.3bn by 2019, according to councils
Structure: Run by NHS England and 211 GP-led clinical commissioning groups Structure: Overseen by 152 councils, but many services are provided by private care firms
Cost: Free at the point of need, but charges made for dentistry and prescriptions Cost: Only those with assets under £23,250 get help from the state. The rest have to pay all their costs
Numbers helped: One million every 36 hours Numbers helped: 1.3 million a year get some contribution to care

In fact, councils argue they are only managing to keep the service afloat at the moment after talking some very difficult decisions. About £1bn a year is being ploughed in to social care from cuts to other services such as leisure centres and libraries.

But this on its own has not been enough. Councils have also had to ration care by raising the eligibility criteria. Four years ago over a quarter of councils were providing help to those with moderate or low needs, now it is nearer one in 10 are.

That means you have to be sicker or even more frail to get help. What is more, social care is means-tested. If you have over £23,250 in assets you will not get any help from the state.

It has meant that at a time when the numbers getting help should be rising because of the ageing population, the reverse has happened. Over the last four years the numbers getting help has fallen by a quarter to just over 1.3m.

So what does this mean for the government's plans? In short, the impact will be limited, according to many experts.

Age UK has been quick to point out that the money being set aside for this accounts for less than 5% of the combined NHS and social care budgets.

The result is that the Better Care Fund will just affect a small part of the health and care system.

It will entitle people to a single assessment - a common complaint is that people have to repeat their stories to the NHS and social care system - and help when it is most needed, such as immediately after being discharged from hospital, or when a person's condition worsens and without extra support they may need to go to hospital or a care home.

What it does not really address is the ongoing support that many of these people need on a daily basis, such as the help with washing, dressing or eating.

For that they will still need to fall back on social care, but, in the words of the Councillor David Sparks, chair of the LGA, which after all represents the councils who run the system, that continues to "let down" the very people it is designed to help.

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