There is a lot of talk about NHS funding and services and there is a lot of talk about social care funding or lack of funding and services but rarely do I see the two linked and yet I consider Health and Social Care to have a symbiance with one another.
At the moment, health and social care – the help given mainly to old or disabled patients to help them continue to live at home rather than in hospital or nursing homes – are different systems in England. NHS medical treatment and domiciliary support, which is provided mainly by local councils, are usually not joined-up.
Adult social care has enjoyed an average annual real-terms growth of 5.1 per cent since 1994 but much of this has been absorbed by demographic pressures. Over the past five years spending on services for people with learning disabilities has risen by 20 per cent and for those with physical disabilities by nearly 14 per cent. But spending for older people has increased by less than 3 per cent and has not kept pace with demographic change, according to the Kings Fund.
Mounting demands on care budgets has led the government to identify additional resources in the Spending Review and to commission an independent review to recommend a more sustainable way of funding care for the future. But a tough spending settlement for local government suggests that a funding gap of at least £1.2 billion could open up by 2017 unless all councils can achieve unprecedented efficiency savings. What's more the last autumn statement made it very clear that there was no extra spending for social care in England.
The consequences are that even fewer people will receive the care and support they need. This will have knock-on effects for people needing NHS care as there will be more emergency admissions to hospital, delayed discharges and longer waits for treatment. Currently there is a battle between the hospitals [A&E] and social care. Someone is taking into hospital and treated medically, they are improved and the hospital wants their bed back, but unless the person can leave under their own steam or are moved by social services, bed-blocking can ensue and this is causing friction.
Social care is not simply an adjunct to the smooth running of the NHS. It is possible that under-investment in vital health services, such as continence and community nursing, may generate additional demand for social care support. A better understanding of the reciprocal relationship between spending in health and social care is essential to ensure that they operate as a whole system of care. NHS Health and Social Care have a symbiance with one another and until this is accepted little progress can be made.