Another day, another damning report from MPs about the state of social care services in England. In truth today’s report from the Health Select Committee provides little that is new. It has been known for a long time that social care services are beset by variation, integration with the health service is limited, services are inefficient and are not delivering the best outcomes for users.
There are exceptions to this, such as Torbay Care Trust in Devon, which are well publicised because they have managed to advance what so many, despite countless attempts, have failed to do. However, these examples of good practice are still too few and far between.
The Government for its part has promised a Social Care White Paper by April which it says will set out a future vision for social care and also provide an update on cross party talks on funding reform. Anyone with an interest in improving the care of those who use social care services is awaiting the White Paper, but what can we expect from it and how close are we to significant social care reform?
Understandably, the main emphasis of the recent debate has been on funding reform and ensuring there is adequate provision for those who need it across the country. Indeed the initial reaction by commentators to the Health Select Committee report today has again focused almost exclusively on the issue of funding and the need to implement the proposed cap on care costs put forward by the Dilnot Commission.
I have previously blogged on the difficulties for the Government of implementing the Dilnot proposals, including the hesitancy of the Treasury in signing off a funding system which does not have fixed costs and will increase year on year at a time when other areas of government are feeling a significant financial squeeze. There are others who go further arguing that the Dilnot proposals are actually unfair and do not chime with the Government’s overall message of ‘we are all in this together’. They would argue that someone with assets of £35,000 and someone with assets of £2 million would end up paying the same in care costs under the proposed system.
Supporters of Dilnot argue that whilst the proposals may not be perfect they are the step in the right direction that is needed to ensure that social care services are adequately funded, particularly when the proportion of the population over 65 is growing.
While funding dominates the political debate there is a danger that funding and implementing Dilnot becomes ‘the only game in town’ in relation to social care reform. Even if Dilnot was implemented in full, few could argue that social care services would be delivering the quality of care needed for those who use them. Indeed funding more Winterbourne Views and Southern Crosses is likely to be one of the reasons for the Government’s hesitancy in signing up to full-scale funding reform. For too long the delivery of social care has focused on delivering against a series of minimum standards and there is a need for new thinking in social care delivery and commissioning.
Reforms to funding thus need to be seen as part of a broader package of care reform designed to improve the quality of services for users, including integrated commissioning, more person-centred care and a focus on outcomes delivered from services. I have previously blogged on how the reforms in the Health and Social Care Bill are looking to re-focus social care services away from counting the numbers of people using services to the outcomes they deliver, through the creation of the adult social care outcomes framework, social care quality standards and a new quality and outcomes dataset for social care.
Increased transparency on quality, outcomes and performance should help drive service improvements for users and lead to greater efficiencies, which in turn will free up capacity in the system that can be used to expand service provision. The mainstreaming of new assistive technologies such as telehealthcare, following the publication of the Whole System Demonstrator results and the launch of the Government’s three million lives campaign can help bring care closer to users, improve outcomes and deliver such efficiencies.
A new regulatory framework is also needed for the new system and the Law Commission’s proposals for a single social care assessment process across the country if implemented would help address the complexity and variations in access to services that dominate the current system. The Department of Health’s reported review of the Care Quality Commission should identify areas to improve the regulation of service provision and ensure that all services are meeting minimum care standards.
Finally, the evolving local structures in the new health and care system will also be critical to delivering improvements in the quality of social care. Health and wellbeing boards will oversee the commissioning of health and social care services at a local level and have the ability to drive through more integrated commissioning by helping to address the current problems many people face around the lack of continuity of service between care settings. Health and wellbeing boards should also encourage pooled budgets which could facilitate the delivery of integrated care. Local healthwatches, if effective, will ensure that patient views are represented in such discussions.
We are getting closer to significant social care reform. A focus on quality, regulation, outcomes, transparency and accountability will all help deliver better a better social care system. However with the White Paper expected around Easter do not put all your eggs in the funding basket.