Telling it like it is…The ADASS annual budget survey came out last week and managed to secure a front page headline in the Guardian, which is no mean feat against the political merry go round of the leadership contest.
The messages in the survey were depressingly familiar; whilst the narrative talked of a further down turn from the ADASS perspective expressed this time last year, anyone who has been talking with local authorities in recent months would be unsurprised at this position.
The report describes social care as being in respectively a ‘sea of inertia’ brought on by policy paralysis and at a ‘significant cross roads’ due to the lack of direction of future policy. Ultimately the message is clear; the waiting game is damaging one and all – the system, communities and people.
Is anyone listening?
On the same morning as the ADASS survey was released, I had been at the Health Plus Care show, hearing Caroline Dinenage talking once again about her frustration at the delay at the green paper being released. On the next day, we had Jeremy Hunt sat in the grounds of the Royal Hospital Chelsea, talking about the importance of social care. Then during one of the hustings, Boris Johnson addressed social care as well, describing it as probably the biggest challenge facing the country. He said he would force home a cross party consensus based around two key principles:
- firstly that no one should have to lose their home
- secondly that everyone should be treated with dignity in old age.
Yet no matter what the politicians say, the paralysis continues.
Of course, there are a myriad of areas for immediate concern within the report including provider closure and contract return, pressures on budgets, workforce challenges and much more. However, there are a number of key elements within the ADASS survey that give me particular cause for concern.
The first of these relates to the 82 per cent of directors who noted increases in rapid discharges to short-term care home placements. The second of these is linked to the 73 per cent who indicated that there had been an increase in avoidable admissions to hospital because of insufficient social, primary and community services.
This topsy turvy outcome of central policy making is of grave concern, particularly when played against a backdrop of political ‘paralysis’.
The decisions to focus on Delayed Transfers of Care has put great pressure on local systems to ensure people leave hospital as soon as able. However, I am increasingly hearing from providers of home and residential care that this means that people are coming to them, often under ‘discharge to assess’ scheme, and they are not in any way well enough to return to their own home; many are inappropriately discharged into residential homes when really they require nursing care.
Often the narrative about the extension of short term stay in care home, to long term or permanent residency is portrayed as a ‘fait a compli’ a trick of fate, or an outcome inevitably underscored by a desire on the part of the care home to retain the person within their care. However, there is surely a need within this report, and more publicly to clarify how this cycle begins and ends where it does.
The analysis of the report tells us that people go into hospitals more frequently than they might need to because there are insufficient services to support them to stay at home. Well, yes that is right. The ADASS report talks of a 45 per cent reduction in District Nursing. , and alongside this, a reduction in local government spending on a wide range of universal services that would support them living at home, such as libraries, day centres, volunteering schemes, citizen advice and many, many more parts of our community infrastructure that have been eroded and sometimes obliterated completely.
The report then goes onto say, when it comes to people leaving hospital, they are ending up entering into the care system at the point of discharge. Again, that is right, and again surely we know why….. because by the time they had been admitted to hospital, they were so unwell and so bereft of resource to sustain their independence and they don’t have a robust home life to return to.
They haven’t experienced the strength based approaches many in local government rightly champion, and often is because many of these people were originally outside of the realm of social services; at the point they enter hospital they are therefore at a point of extreme crisis.
For me, whilst the report highlights these elements, it does not do enough to join the dots in a way that gives politicians the clear and coherent message about what it is that must change if we are to move from this point.
To enable a reduction in demand for long term health and social care, the report talks about the aspirations of Directors to invest in asset-based approaches and prevention. But could it go further to make the demand that recognises that in order for this to happen there has to be a local level shift of resource from health to prevention focussed social care.
Could it articulate that for every delayed transfer of care prevented, and every unnecessary admission avoided, the savings are poured back into exactly those preventative services called social care that the authority rightly aspires to commission?
The final comment in the opening pages of the report states:
Of course, this is right.
But we should also be aspiring for a life, for pride and for change.
For a report that has been essentially written by 150 Stephen Chandlers’, the DASS who so poignantly shared his experience of commissioning within Somerset for the recent Panorama programmes, it came across as a report that at times held its punches.
We need to add our voice to the challenges that ADASS reports on – and will look forward to working with the President and her colleagues in ensuring the new Prime Minister takes social care up to the top of the political agenda.