The Government’s health and social care reforms have placed significant emphasis on the integration of services to improve the quality of care for people and deliver greater efficiencies. In practical terms, the Government has put its money where its mouth is by allocating an additional £2 billion per annum by 2014/15 to social care through the NHS, including the establishment of a dedicated re-ablement fund to support people recovering from hospital. But how is this working and how is the money being spent?
MHP Health Mandate’s new report An atlas of variations in social care reveals that £115 million of Government expenditure earmarked as ‘additional’ in 2011/12, and to be transferred from the NHS to local authorities for improving social care, is being used by commissioners to prop up eligibility criteria for existing services. Eligibility criteria are the indicators and measurements used to assess people’s social care needs and the services they should be able to access.
Our research, as covered by The Daily Telegraph and the Local Government Chronicle, found that two of England’s largest cities – Sheffield and Manchester – spent all of their ‘additional’ funding (over £15 million) on maintaining existing services.
Our research found that two of England’s largest cities – Sheffield and Manchester – spent all of their ‘additional’ funding (over £15 million) on maintaining existing services.
An atlas of variations in social care reveals the financial and personal costs of variations in social care provision. Our research suggests that, the number of emergency re-admissions to hospital for over 75s within 28 days of discharge could be reduced by 227,400 in England if all councils could reduce their admissions to those of the best performing quarter of councils. Such improvements could result in a national saving of £318.4 million per year for the NHS.
We found there is a greater than seven-fold variation in the proportion of older people receiving homecare following a care assessment (defined as a person receiving more than ten hours per week of care in their own home). This is in spite of Government initiatives to increase the opportunities for people to be cared for at home and unlock the efficiency savings this can potentially deliver. In some areas, 1 in 5 people are able to access homecare following an assessment, but in others this falls to 1 in 25 people. The reasons for this variation are unclear.
The importance of people with mental health issues needing access to services across public health, NHS and social care was a clear theme of the Government’s mental health strategy, No health without mental health. However, just 4% of the additional £648 million for social care in 2011/12 was spent on mental health services. Given this, it will be interesting to see what proposals are set out in the coming mental health strategy implementation plan to ensure an integrated approach to care.
There were several other striking variations. For example, there is nearly a six-fold variation across local authorities in the weekly expenditure on self-directed support. This is an area that should be looked at further given that the full implementation of personal budgets is under a year away. We also identified a 20% difference between the best and worst performing local authorities in the proportion of people describing themselves as either ‘extremely’ or ‘very satisfied’ with the care and support services available to them. Furthermore, based on the Government’s own figures, over 500,000 people will die in a place not of their choosing over the remainder of this parliament.
There is no doubt that the current social care system is inadequately funded, over-stretched and under-delivering. However as this atlas shows, funding more of the same will not necessarily deliver better care and outcomes for users.
While funding reform is certainly needed, this needs to be coupled with substantial reform to the legal and quality frameworks that govern the delivery of social care services in order to be truly effective and transformational. Our report sets out 30 recommendations to improve services and update the social care quality framework to align it with the underlying drivers of NHS reform to provide a higher quality, tailored and more efficient, service for its users, their families and carers.
By adopting a new quality framework for social care as part of the forthcoming Care and Support White Paper, there is an opportunity to deliver service improvements efficiently that can simultaneously result in tangible benefits to social care users, families and carers.
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