Social care and the NHS - moving forward together?

13/09/2024

Today Lord Darzi’s report of the Independent Investigation into the NHS commissioned by the Labour government was published, and we set about reading it eager to see how the Venn diagram of health and social care was presented. 

Social care and health care have long been vying for the attention of government leaders, both desperate for extreme levels of intervention. Decades of functioning in silos has had a hugely detrimental impact on those relying on both, and we have heard firsthand the devastating harm caused to older people stuck in hospital, through no fault of their own.  

With a new government in post, it is an opportunity to finally draw this gap to a close and safeguard those who have gone without appropriate support for too long. 

What does the Darzi report say about social care? 

From the beginning, Lord Darzi sets out to Wes Streeting that social care is in a “dire” state, explaining that 13% of NHS beds are occupied by people waiting for social care supporter care in more appropriate settings. We welcome the early acknowledgement that the important themes that transpired for repairing the NHS would need to be explored alongside social care reform. 

Lord Darzi also recognises that publicly funded social care is provided for fewer and fewer people while the demand for it has risen, largely as the result of an ageing population. Analysis by the King’s Fund is cited, which found a huge gap between resources and need, with the Local Government Association highlighting that the vacancy in adult social care is nearly three times that of the economy of the whole. 

The report describes a key difference in the NHS and social care, that “the NHS is funded by taxpayers and free at the point of need, social care is means-tested and only provided to those with the greatest need and least ability to pay.” The impact of this is that people remain in hospital beyond the point where they have stopped receiving medical care.  

A quote from The Times explains: “a person who needs medical care for cancer will receive it without any discussion of their means, but one who requires social care for dementia can expect to see a large proportion of their assets and savings taken by the costs of the illness.” The report insinuates that individuals are perhaps staying in health services longer due to the lack of cost, and though funding issues have long plagued those trying to access vital care, it is imperative to remember the life-changing impact on the individuals at the heart of this. 

Older people can all too quickly lose their mobility and experience a worsening of conditions such as dementia when forced to have extended stays in hospital, leading to premature need to move into care homes. When the local authority doesn’t have social care provision ready yet and hasn’t appropriately assessed an individual’s ongoing support needs, they can be left confused and distressed, often in places where their needs aren’t fully met. 

It is fortuitous that this report has stirred up essential conversation around the huge overhaul needed both to save the NHS, and to reform the social care sector. Despite a commitment in the Labour manifesto to develop a National Care Services, organisations such as ours who support people accessing social care were growing increasingly anxious at the deafening silence on the subject since the general election. 

We are now pleased to hear explicitly from Keir Starmer that social care reform is in his ten-year plan, though we can’t help but think of the older people accessing care that need support today. 

We eagerly await more detail on the short and medium-term steps that need to be taken in the interim. The message from organisations within the NHS and social care, and the people accessing these vital services is clear - they need to change, and they need to change together.