‘Whatever it needs, whatever it costs, whether it’s millions of pounds or billions of pounds…we stand behind the NHS,’ were words used by the Chancellor in his budget last week.
I kept waiting for his pronouncements on the crisis in social care, but it didn’t appear. It left me thinking that this was one important part of Rishi Sunak’s giant budget give-away, in which he couldn’t claim the government was ‘Getting Things Done.’
There is a chronic underfunding in the social care sector. Over 1.4m of the UK’s over 65’s have un-met social care needs (up from 1.2m in 2017 and 900,000 in 2014).
Admittedly, the Chancellor has a lot on his plate at the moment, what with the coronavirus epidemic and leaving the EU. But, let’s not forget, the government has already kicked the social care can down the road on several occasions over the past three years. They can’t keep doing it forever.
Unless you have personal experience of the UK’s social care needs, you possibly don’t appreciate the urgency of the problem. I do.
For more than a decade during my day job as a corporate solicitor and head of a large multi-office Company and Commercial Legal Department, I have bought and sold countless care and nursing homes for clients. I have also met with the Regulator (CQC) multiple times to discuss the quality of care provided by various different operators and I have attended numerous meetings with local authorities to discuss their concerns about the impending shortage of care beds in their regions. As a result, I know more about the Care Act 2014 than is probably good for me.
Between 2010 and 2018, Whitehall’s payments to local authorities to help fund social care, fell from £22bn to £21.3bn. Consequently, local authorities were unable to increase the fees they paid to private operators. At the same time, care operators have experienced hugely rising costs following the introduction of the national minimum wage, the onset of workplace pension payments and the ever-increasing requirements of CQC. These factors have all contributed to the collapse of around 400 care homes over the past five years.
Care and nursing homes are the poor relations of health and social care. The IPPR thinktank estimates that an extra £7.5bn will need to be spent in the care home sector by 2030 to meet the anticipated demand and creating an additional 75,000 beds.
The UK has an ageing population, yet between 2000 and 2017, the number of hospital beds fell from 241,000 to 167,000. At any one time, around 25 percent of the UK’s 850,000 dementia sufferers are in UK hospitals.
One way to alleviate the pressure on hospital beds is for the private sector to be incentivised to build new, dedicated dementia homes, and to transfer dementia sufferers into them from the hospital. Dementia is a specific medical condition requiring a particular type of care. Dedicated dementia homes are actually better equipped to provide it that hospital wards.
The daily cost of a dementia resident in a care home is far less per day than if the same person were kept in an NHS hospital. I know this because I have heard local NHS managers virtually ‘begging’ care homes with which I am associated, to give them long term dedicated care home beds. The NHS is already willing to pay more for these block bookings than the standard local authority dementia rate.
By the NHS guaranteeing long term NHS funded dementia care contracts of this nature, it will attract private sector capital to build more dementia homes, safe in the knowledge that a secure income stream will be forthcoming. And, we can see from the UK’s demographic path, that there will be no future shortage of residents.
The effect of this would be to free up a large number of hospital beds, which we need anyway to look after our growing population.
The National Health Service is hugely popular and is regarded as something of a sacred cow (regardless of the inefficiencies we know about, but which successive governments are shy to acknowledge). Because of this, taxpayers will be more kindly disposed to increased funding going directly to the NHS.
At the same time, this will take the pressure off local authority budgets, 57 percent of which in 2019 (according to the Local Government Association) was spent on social care.
Yes, it will create a bigger NHS budget overall. But dementia care will be delivered better, more efficiently and less expensively, attracting more private capital into the health sector and freeing up hospital beds for other patients.
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