This winter has been bad for the NHS for many reasons, not least of which has been the lack of social care for those medically fit for discharge. In the last year alone, the number of care homes for the elderly in England has fallen by 1,500, or 8%. Local councils now spend more than 50% of their budget on social care, but they cannot keep pace with the rise in demand or the decrease in central government funding. Indeed, in 2015-16 up to £2bn of effective subsidies for community care came out of the NHS either directly or through delayed discharges. One in three of those in need get little or no care at all, one in eight fund it themselves, another third rely on friends and family and only about one in five get most of their support through local authorities. (1)
The causes are well known - rising life expectancy means we have more retired people and a smaller tax base of working people to fund care. Families are more dislocated and fragile, so family is often less able to provide care than in the past, but even where they can, it is now for much, much longer than in previous generations.
One key problem is funding. We do not have a system (private or nationalised) to save up money for our future care needs. Consequently, it falls on over stretched and underfunded local services or personal assets (including houses and life savings) to fund care. A national care insurance programme may be a long-term solution. (2) Integrated health and social care budgets and organisational structures may offer a quicker fix, although the evidence for this has yet to emerge. (3)Another is to form new kinds of multi-generational households - not just consanguinal family, but other forms of shared households, such as the model pioneered by L'Arche. (4)
The Church and Christian organisations have a key role to play in all of this - from providing social support and community integration for vulnerable people and their families and carers, to running essential services and raising funds. Indeed, many already are at the cutting edge of meeting these needs. (5) This is an area where we have a lot to contribute as health professionals.
Whatever the way forward, it will require new thinking, new cooperation and leadership at all levels, from government to the local community.
Review by Steve Fouch CMF Head of Nursing
The causes are well known - rising life expectancy means we have more retired people and a smaller tax base of working people to fund care. Families are more dislocated and fragile, so family is often less able to provide care than in the past, but even where they can, it is now for much, much longer than in previous generations.
One key problem is funding. We do not have a system (private or nationalised) to save up money for our future care needs. Consequently, it falls on over stretched and underfunded local services or personal assets (including houses and life savings) to fund care. A national care insurance programme may be a long-term solution. (2) Integrated health and social care budgets and organisational structures may offer a quicker fix, although the evidence for this has yet to emerge. (3)Another is to form new kinds of multi-generational households - not just consanguinal family, but other forms of shared households, such as the model pioneered by L'Arche. (4)
The Church and Christian organisations have a key role to play in all of this - from providing social support and community integration for vulnerable people and their families and carers, to running essential services and raising funds. Indeed, many already are at the cutting edge of meeting these needs. (5) This is an area where we have a lot to contribute as health professionals.
Whatever the way forward, it will require new thinking, new cooperation and leadership at all levels, from government to the local community.
Review by Steve Fouch CMF Head of Nursing
