Adult social care is reported to be facing a £1.9 billion funding gap in 2017. A number of organisations have highlighted an urgent need for increased funding in order to relieve the pressure on health services.
A number of healthcare organisations, politicians and health charities are warning that there is a need to tackle the gap in funding for adult social care in order to relieve increasing pressure on the NHS. The Care Quality Commission’s report on the ‘State of healthcare and adult social care’ (2015/16)1 found that there is some evidence of a deterioration in care quality, with some providers struggling to improve their rating beyond ‘requires improvement’.
The CQC found a great deal of good and outstanding care – particularly in children’s and young people’s services and critical care. However, too much acute care was found to be ‘inadequate’ – particularly in the areas of urgent and emergency services and medical services. It warned that it will be increasingly difficult for NHS Trusts to make improvements to these services unless they are able to work more closely with adequately funded adult social care and primary care providers.
The CQC commented that: “The fragility of the adult social care market and the pressure on primary care services are now beginning to impact both on the people who rely on these services and on the performance of secondary care.”
It stated that the combination of a growing and ageing population, more people with long-term conditions, and a challenging economic climate meant greater demand on services and more problems for people in accessing care. According to the CQC, this is translating into increased A&E attendances, emergency admissions and delays to people leaving hospital, which in turn is affecting the ability of a growing number of Trusts to meet their performance and financial targets.
Health Committee: pressure on A&E
The Health Committee has also warned that unless the shortfall in social care provision is addressed, people will continue to face avoidable admission and delayed discharge from hospital, and has called on the Government to provide urgent funding.2
Dr Sarah Wollaston MP, chair of the Health Committee, commented: “Accident and emergency departments in England are managing unprecedented levels of demand. The pressures are now continuing year round without the traditional respite over the summer months as departments try to cope with increasing numbers of patients with complex needs.”
For major emergency departments in 2015, only 88% of patients were admitted, transferred or discharged within four hours, well short of the 95% standard set by the Government. This figure masks great variation in the performance of Trusts, which cannot be explained by financial challenge, demographics and demand alone.
The Health Committee report points out that some Trusts are supporting patient flow out of hospitals by creating their own services that provide social care in order to address the problem of delayed discharge. These initiatives, however, have a limited scope when Trusts are themselves under such financial pressure. The Health Committee said that investing in social and intermediate care should be a priority.
The current level of variation in meeting the four-hour waiting time standard is also due to differences in the way that Trusts manage flows within hospitals. While there are examples of excellent practice and systems alongside a culture of all staff supporting the A&E department because of its importance to patient safety, there are also examples of poor performance worsened by inadequate systems which have been allowed to continue for too long. Long waits for ambulance staff to transfer patients to A&E departments are unacceptable and must be addressed, the Health Commitee argued.
Struggle to manage demand
As identified by NHS England’s chief executive, emergency departments will struggle to manage demand unless additional infrastructure funding is made available to those struggling in inadequate premises. The Health Committee says that it is essential that the Government ensures that sufficient capital funding is available for Trusts to develop the infrastructure that will enable them to meet performance levels demanded by Ministers. The first step will be an assessment of the infrastructure investment required to ensure that type 1 emergency departments are fit for purpose, which should be completed through the Sustainability and Transformation Plan process.
Call for sufficient funding
The report calls on the Government to make sure that sufficient funding is available to support the infrastructure investment required to ensure that type 1 emergency departments are fit for purpose, and to review the real terms cuts to NHS capital budgets. The Committee calls for NHS Improvement to consider the steps that it can take this winter to ensure that all A&E departments are properly staffed and for Health Education England to look again at the long-term sustainability of staffing, including for paramedics, within major emergency departments and the ambulance service.
Three leading health charities have also issued a call for the Government to address the gap in social care funding.3 In a recent briefing, the Health Foundation, The King’s Fund and the Nuffield Trust analysed the state of health and social care finances, concluding that cuts and rising demand will leave adult social care facing a £1.9 billion funding gap in 2017.
The three organisations concluded that, despite mounting pressures on the NHS, finding money to plug this gap is the most urgent priority. They urge the Government to bring forward planned increases in social care funding through the Better Care Fund, warning that, without this, thousands more older and disabled people will be denied access to the care they need, with severe consequences for the NHS. This follows a 9% real terms cut in social care spending by local authorities between 2009/10 and 2014/15, which has led to 400,000 fewer people accessing social care.
The three organisations also warned that the planned increase in the Department of Health’s budget between 2015/16 and 2020/21 will not be enough to meet rising demand for services, maintain standards of NHS care and deliver the changes to services set out in the NHS Five Year Forward View. The briefing warned that the pressures on the NHS will peak in 2018/19 and 2019/20, when there is almost no planned growth in real terms funding, and argues that the Government will also need to consider additional NHS funding in future financial statements or be clear about the consequences for patient care.
The analysis shows that health spending in England will increase by £4.2 billion over this parliament, an average rise of 1.1% per year in real terms. This is almost identical to the increase in the last parliament and much lower than average annual increases of nearly 4% since the NHS was established, despite rising demand for services. It is also much lower than the funding increases for the NHS cited by the Government as it covers all health spending, not just the budget for NHS England.
Richard Humphries, assistant director for policy at The King’s Fund, said: “Cuts to social care funding are leaving older and disabled people reliant on an increasingly threadbare local authority safety net. For many, the care they get is based not on what they need but on what they can afford and where they live. More people are left stranded in hospital. This Government has committed to creating a country which works for everyone, and they now need to match this with action.”
Anita Charlesworth, director of research and economics at the Health Foundation, said: “On too many occasions over the last few years the approach to funding for the NHS and care system has been to rob Peter to pay Paul: social care cut to protect the NHS, budgets to train new doctors and nurses reduced to fund care now, capital budgets raided to meet day-to-day costs. It is absolutely clear that this is not sustainable and has undermined the drive to improve efficiency. While the pressures on the health service are very real, the case to prioritise social care funding is compelling.”
John Appleby, director of research and chief economist at the Nuffield Trust, said: “After years of austerity, by the middle of this parliament we will start to see the amount of NHS money per person actually fall in real terms. In this context, providing high quality healthcare that meets the needs of a growing and ageing population will put the NHS under enormous pressure. We are likely to see this expressed through an explosion in waiting lists, patients being denied new drugs, or hospitals going even further into the red. These would neither be desirable for patients nor for the Government and action is needed.”
1 CQC, State of Care, October 2016, http://www.cqc.org.uk/content/state-of-care
2 Health Select Committee, Winter pressure in accident and emergency departments, 3 November 2016. www.parliament.uk
3 Press release, Nuffield Trust, ‘Health charities warn of £1.9bn social care funding gap’, November 2016, accessed at: http://www.nuffieldtrust.org.uk/ media-centre/press-releases/health-charitieswarn-%C2%A319bn-social-care-funding-gap
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