Major report underlines social care crisis

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At 88 pages, the Adult Social Care Ninth Report of Session, published by the House of Commons on 27 March 2017, takes some digesting. However, anyone following the downward spiral of social care as funding has tightened, will know that this Report was always going to contain some unpalatable truths. This is a serious document that needs to be acted upon, and soon, even while the whole of Whitehall seems turned towards the challenge of Brexit.

Whilst the finger is pointed clearly at Government, no one stakeholder is blame free, apart from the end user , the person waiting for a service, possibly in hospital, but more probably at home and their carer, if they have one.

We know that Local Authorities with responsibility for adult social care are stretched. The Report hammers this home; fewer than one in twelve Directors of Adult Social Care are fully confident that their local authority will be able to meet its statutory duties in 2017–18; councils are stretched to breaking point managing all their statutory duties in addition to social care. Despite relative progress in Oxfordshire services, CQC tell us that 28% of care services are inadequate, or require improvement. It would be useful to know whether this is an increase or decrease on previous years, but, as with Ofsted and schools, since the playing field is ever changing, we do not have year on year comparisons. And the rating of ‘Requires Improvement’ covers a myriad of issues, from a piece of paper out of date, to some serious work to be done.

And then, the House of Commons Report treats us to some quite appalling statistics: some councils pay £2.24 an hour for residential care; 49% of home care workers are on zero-hour contracts, compared with 2.9% of the workforce nationally; and the median hourly pay for a care worker is £7.40.

Whilst none of those last three is true for Oxfordshire, do not be under any misunderstanding that this is a sector under severe stress, including in our own County. We do have high turnover in parts of our social care sector and, in amongst our ‘Outstanding’ and ‘Good’ services, there is clearly room for improvement. However, we have ongoing dialogue with commissioners and providers come together is various forms on a regular basis to discuss issues and to share ideas – it’s a platform for improvement. But we would wholeheartedly agree with the list of challenges as set out on page four of the Report, which variously are the result of a perfect storm of stringent funding cuts, a rise in, and more complexity of, need, a diminishing of community infrastructure (such as public bus services and bumping places, such as post offices), unobtainable housing provision and crucially, but unmanageable, a now culture that focuses on self and little else. Why care for someone else, when you can update your status?

Councils are providing care and support to fewer people and concentrating it on those with the highest needs with care being rationed as the minimum required for a person to get through the day. This passes the responsibility, or burden if you like, though I do not like that word particularly, down to unpaid family carers and their community. Whilst Oxfordshire has always struggled with delayed discharges, there is no doubt that the pressure on social care is having an impact on the NHS, itself at breaking point.

We would also highlight that the drive to the bottom in terms of fees, is adding to mix, forcing providers to choose between training or delivery, thus having an impact on retention. Oxfordshire may be one of the best payers, but why shouldn’t it be; Oxfordshire is consistently listed as one of the most unaffordable places to live. However, some parts of the local sector have not had an increase in contract prices for more than five years. Not only does that disregard the insistent upward economic pressures, but is also deeply disrespectful to hard-working providers and their staff.

So much for the doom and gloom, are there any solutions? Yes, there are. Whilst pushing for a better settlement, we also need to look at resources that we don’t currently use. Our communities are an untapped resource as long as we don’t use them as a holding place, or dumping ground. But, there must be investment either in those communities, or in the direct provision. Failure on either front will inevitably bring down the sector. The Report suggests that funding for social care could partly come from reducing subsidised bus services, but this would mean dis-investing in current infrastructure.

Doing nothing is not an option.