Five acid tests for the social care green paper | Sir Robert Francis QC

Sir Robert Francis

Following Healthwatch’s recent survey on social care, Sir Robert Francis QC, chair of Healthwatch England, reveals five key tests that will help government achieve the improvements across social care that people are asking for.

Social care is often thought of as the poor cousin of the NHS.

It is all too common for the political and media narrative around social care to frame the sector as one whose core function is to relieve the growing demand on our acute hospital services.

However, people working in the NHS know this is not the case and that social care is invaluable in its own right.

But, unlike the NHS, social care is not well understood by the public; the view that the NHS and social care are one and the same is pervasive.

Rarely are people aware, until such time that they require social care, how limited their options are, the fact they may need to pay for care or that it is their council, not GP, who acts as gate keeper.     

Healthwatch insights

Over the last year, the Healthwatch network heard insights from over 9,000 members of the public about what they thought of and expected from social care. We also heard from over 5,000 unpaid carers about their experiences accessing and using support services.

One over-arching theme that emerged from this insight was that people simply don’t know where to start when it comes to planning for social care. What’s more they have little motivation or incentive to do so.

  • Only 1 in 20 of us have made plans for social care in later life.   
  • Of the people we surveyed, two thirds said that their local general practice would be their first port of call if they had to start planning social care for themselves or a family member.
  • The fact that people so often defer to their GP as a source of information is primarily down to the fact that people trust that service above all others.
  • Four out of five of us would trust our local primary care service to provide accurate and impartial advice. While the number who express very high levels of trust in GPs is double that for councils.

Resourcing information

The issue here is that primary care services rarely have the resource, expertise, capacity or connections to provide the sort of social care advice service so many people approach them for.

A regular point of confusion is the apparent arbitrary nature of what is covered by social care and what falls into the remit of the NHS. To clinicians and the public alike, there is little logic behind the fact that a person with dementia will be subject to the rigorous means and needs testing of social care, while a cancer patient will not.

Councils too are facing considerable resource pressures and are struggling to manage demand for social care.

Across the board, there is an urgent need for investment in effective signposting, information and advice. This is a role that local Healthwatch is well positioned to fulfil, though unfortunately local commissioning and funding arrangements mean this is often not possible.

Forward planning, not crisis planning

For many people the key decisions they take about social care are made under extreme duress, at a time of crisis when their need is immediate and the option to defer planning has expired. The urgency of crisis planning, so common in social care, limits people’s choice and confidence. Our research found that when people with support needs or carers do reach that point of crisis and approach their council for support, they face an average wait of two months to get the support they need. These issues are ones that will take a concerted effort to resolve, from politicians and those of us who work in health and social care to, most importantly, the people who use services and will use them in the future.  When the government publishes its long-anticipated social care green paper it will have the chance to do just this. It is an opportunity we cannot afford to miss. The challenges are considerable, though well known. In terms of solutions, we have plenty of ideas but no commitment to a route forward.

Five key tests for the social care green paper

Using our insight and research, we have developed five key tests, that if passed by the green paper, will help us achieve the improvements across social care that people have told us they need to see. 

  1. Is it understandable to the public and people who work in social care?
  2. Will it support people to plan and make decisions about their care?
  3. Does it facilitate a wide range of choice in social care in a stable and varied provider market?
  4. Are the funding, charging and access thresholds fair, affordable and transparent?
  5. Will it support families and carers?

The social care green paper is unlikely to be a panacea, nor should we expect it to be. It must however, be the first step in reforming and improving our struggling social care system.

We have set out five clear, achievable tests for the green paper, ones that must be met and exceeded if we are to have any realistic expectation of achieving the kind of social care system that we need and deserve.

Sir Robert Francis QC is chair of Healthwatch England. Follow the organisation on Twitter @healthwatche

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