When I last wrote about social care funding (Why are we waiting?), I implored our policy makers to produce a workable solution to end the uncertainty many people face about how they will pay for care. The recent announcement by the government that introduced measures designed to stop families having to sell their homes was generally welcomed, but so much more needs to be done to change the face of social care in England.
I have never understood, and I don’t think I ever will, the way in which we have managed to compartmentalise healthcare and social care. To me they are pretty much one of the same thing. Good social care alleviates the burden on the healthcare system. When people are cared for well within the social care structure, whether that is in their own home, or in a care home, they place less of a burden on the health service, freeing up beds in hospitals and appointments in clinics.
Yet while we have a National Health Service for healthcare, social care is a means tested system where financial goalposts can be moved by politicians and where, even under these latest proposals, so-called accommodation costs, such as food, heating and paying for a room in a care home are not part of the cap. So even though someone may need to be in a care home to receive the care that they require, for their wellbeing and safety, and certainly need to eat and keep warm in order to remain in good health, they are still expected to pay for that if they have the ability to do so (the cost will be around £12,000 in April 2017).
That would be perfectly fair enough, if only the same applied to healthcare. Yet that is free at the point of need, something I must add I wholeheartedly support, but I just feel that social care has become the poor relation. You can go to hospital, be given accommodation and fed, and yet surely we should be supporting people to avoid doing that precisely because acute care facilities cost so much and are under huge pressure, not to mention the negative effects on patients from lengthy stays in hospital.
Then there is the question of what happens to people when they enter what I would call the social care funding no-mans-land. Their need for social care has been identified, but the assessments need to take place and appropriate care sourced. Imagine what might happen to someone who doesn’t recognise their own need for care and doesn’t want to pay, or someone who knows they need care, cannot afford it, and must wait on one of these drawn out assessments of their finances to confirm that. In that intervening period they could easily hit a crisis point and end up needing our healthcare system to pick up the pieces, usually at great expense.
Then there are those who need social care when they are facing the end of their life. Hospices are wonderful, but there aren’t enough of them and they are generally focused on cancer patients. They don’t usually help people with dementia for example. So you could end up dying in hospital, something most people would never want to do, at home with less than adequate care if you don’t have a package of care funded, or die waiting for a bed in a care home to be found and funded. These ‘solutions’ are hardly something for our society to be proud of at this most sensitive time in someone’s life.
How can we ethically allow social care to continue to be the poor relation in the ‘care’ family? Health and social care should be a partnership, yet when it comes to financial demands, so often it is a competition to see which side can palm off their patient onto the rival just to ease their own budgetary constraints. As the desire for CHC funding has escalated, many people have even started up businesses to advise families on how to appeal, even after a relative’s death, against a decision to deny funding.
Then of course, like so many aspects of the ‘care’ family, you are also subjected to the postcode lottery when it comes to funding. Local authorities it seems are at liberty to interpret the rules on someone’s care needs differently, so while in one location you may be assessed and receive full funding for care, in a neighbouring authority the outcome may be very different.
Admittedly you can now argue that at least by April 2017 people won’t, in theory, have to sell their homes to pay for care, but for everyone currently within the social care system, and those about to enter it, that is fairly cold comfort. The social care system isn’t fixed by such a relatively narrow adjustment in the parameters, and many families still face uncertain futures.
Yes, you may get to keep the family home, but what you will go through to find care, fund it and live with the consequences of a system where standards are often not what they should be means that you are hardly likely to be celebrating from the rooftops. Ultimately social care needs an overhaul that transforms this fractured system and makes it equitable to healthcare. It requires joined-up thinking on a vast scale and a recognition that, with an ageing society, social care has to be amongst the very greatest priorities that politicians of all persuasions have.
Until next time…