As I said earlier, I will come to our proposals; I do not want to jump around in my speech too much more.
Going back to staff working in social care, it is important to remember and think about social workers, not just care staff. A recent study found that less than half the social workers surveyed felt that decisions about a person’s care and support were being left to their professional judgment; it is now all about budgets. More than a third said that they had felt unable to get people the care they need. Less than half felt supported to have necessary difficult conversations about changes to care with people needing care and their families.
The social care crisis is a direct result of the cuts that this Government have chosen to make. The King’s Fund, the Health Foundation and the Nuffield Trust estimated that there would be a funding gap in social care budgets of £1.9 billion for this year, but the extra funding in the Budget was only £1 billion, so there is still a funding gap of £900 million this year. Labour pledged an extra £1 billion for social care this year to start to deal with that funding crisis. However, the Government have chosen instead to put the pressure on local authorities and hard-pressed local council taxpayers to deal with that social crisis, which was made in Downing Street.
Delayed transfers of care due to social care cuts increased by more than a quarter in the 12 months to August this year, putting extra pressure on local councils. Now, sadly, Ministers are threatening councils with fines and further funding cuts to social care if targets for cutting delayed transfers of care cannot be met. Indeed, ADASS reported that half the social services directors it surveyed believe that their targets for delayed transfers were unrealistic. It is barely believable that the Government’s response to the social care crisis is to threaten to make the situation worse by cutting funding for social care even further. Some councils experiencing problems meeting targets were even summoned by NHS leaders last week to a meeting to review their performance challenges.
Many people have said that the approach of blaming and penalising local councils is not sustainable. The Conservative chair of the Local Government Association, Lord Porter, said of the warning letters sent from Ministers to councils:
“No council wants to see anyone stay in hospital for a day longer than necessary. These letters are hugely unhelpful at a time when local government and the NHS need to work together to tackle the health and social care crisis.”
The president of the ADASS, Margaret Willcox, has described the Government’s actions in threatening councils with further sanctions as, “frankly bizarre”. David Oliver, who is clinical vice-president of the Royal College of Physicians and a geriatric consultant, said about delayed transfers of care:
“Some of these delays are due to systematic cuts to social care budgets and provision. Others are due to a serious lack of capacity in community healthcare services…attempts to solve the problem through initiatives like the Better Care Fund or pressure from NHS England have failed”.
Interestingly, Andrea Sutcliffe, the chief inspector of social care at the Care Quality Commission, said:
“I worry that if people focus just on moving people through the system quickly then does that mean that they will force the discharge of somebody that is old and frail into a service which we have rated ‘inadequate’”.
We now have a Government who are driving the NHS to be obsessed with dealing with delayed transfers of care, seemingly above all else. This obsession causes further problems if patients are discharged without planning what they need outside hospital.
Age UK give an example that was brought to them:
“Terry’s father Richard, 85, is in hospital following a stroke. He is ready for discharge and has been assessed as needing rehabilitative care through two home visits a day. However he was then told that there are no reablement services available in his area. Terry has been told to ‘get his father out of hospital’ and to look for and fund the care himself.”
My own local hospital, Salford Royal, sadly seems to have similar issues. Last week, I spoke to a constituent who described her own discharge by saying, “I was thrown out of hospital.” Having had surgery for an infected bite that caused sepsis and a hand that she could not use, my constituent was given no discharge summary, no advice on how to manage her wound and no advice about her recovery. When she struggled to get dressed, she was told that she had to get out quickly, otherwise, “This will count as a failed discharge.” This a theme we may remember from last winter.
I remind the Minister that the British Red Cross talked then of a humanitarian crisis whereby people were sent home without clothes or into chaotic situations. Those chaotic situations involved them falling and not being found for hours, or not being washed because there were no care staff to help them. Ordering patients out of hospital when there is no reablement service for them, without advice about wounds or recovery, or to a care facility rated as inadequate just to meet unrealistic targets on delayed discharge is a recipe for an even worse crisis this winter.