Health Policy August 8, 2019
How do we tackle the giant of social care?

By News Feature - Accountable Care Journal

Developing a progressive social care system to meet the needs of citizens while balancing service provision with funding and workforce pressures is a challenge that has defeated many in Westminster and Whitehall. So much so that the green paper on the issue has been delayed by two years. Add substantially growing demand driven by an ageing population and ongoing Brexit uncertainties, and the need for a fully future-proofed system becomes ever more pressing.

A roundtable discussion, hosted by Public Policy Projects and chaired by David Walker from Oxford Health NHS Foundation Trust, gathered thought-leaders from across the sector to establish the policy of the political left, in the absence of any movement from the then government.

Integrating with the wider sector 

There are a multitude of ongoing conflicts between the health and social care sectors, encompassing funding, service provision and care delivery. These are caused primarily by a lack of integration at a system level. Despite sharing a government department, healthcare is governed at a national level through the NHS, whereas social care is primarily governed locally. Because they operate on the basis of entirely different funding frameworks, collaboration and joint working have historically been near impossible.

While these systems may operate in isolation, any action taken by one is likely to be highly impactful on the other. NHS demand is highly dependent on the quality of service provision in social care and, symbiotically, the causal links are equally strong in reverse, to the benefit and detriment of patient health outcomes.

A number of policy steps have been taken to address this divide, most prominently with the publication of the NHS Long Term Plan (LTP) which placed integration at its heart for healthcare services, paving the way for the development of Integrated Care Systems (ICSs). However, despite this focus, many in the sector question whether the LTP goes far enough to integrate health with social care or whether a complete system overhaul is required.

The notion of a universal health and care service is an idea bandied about by many but is left adrift by a lack of substantial policy backing surrounding the economic and operational implications. The 2017 Labour Manifesto stated that, should they form a government, the Party would instigate a move towards free personal care in England. However, thus far, there isn’t a politician who has adequately grappled with the issue. A broad lack of public understanding in England of what ‘free’ personal care actually means presents additional challenges to winning votes with this angle of political messaging.

Ageism in policymaking

Thought-leaders at the roundtable made the case that there is inherent ageism in policymaking. This is grounded on the basis that people with diseases such as Alzheimer’s and dementia are expected to pay for their care, whereas other groups are not, for equally debilitating conditions. Someone living with advanced dementia, for example, has probably got the same level of cognitive function as some living with learning disabilities. However, they are treated completely differently by the system, in terms of aspirations and costs of their care plans.

The difference is founded on the clinical assessment of individuals for these different conditions. A person with Alzheimer’s is not clinically assessed in the same way as those with learning disabilities. If services were based on need regardless of age, this inequality would be addressed, regardless of the patient pathway. To tackle ageism, the roundtable proposed that Labour and the 'progressive left' should consider a needs-based allocation of services.


There is also a need to bolster the appeal and 'perceived status' of the social care workforce. This sector is larger than healthcare yet faces many of the same pressures. However, workers do not get equal recognition for their efforts. Furthermore, with the development and adoption of new technologies across health and social care, there are many who advocate the use of digital to reduce the burden on the workforce. However, it is reasonable to warn that this can only go so far. Monitoring technology can help raise alerts but care will always need to be administered by a person. If we had a national care service, a natural balance may develop.

Workforce recruitment, training, development and retention are all issues that plague social care. The political left would need to implement a comprehensive workforce strategy to manage the adoption of new technologies and ensure that workers are supported and offered progression opportunities. We have recently seen the appointment of a Chief People Officer in the NHS and the publication of an Interim NHS People Plan. There is a stirring of movement towards tackling workforce issues and the progressive left must utilise this to develop a truly informed and comprehensive workforce strategy.

The recommendations of the roundtable are as follows:

  1. Social care should not be viewed in isolation. Labour and the progressive left need to implement a holistic policy that works to break down the silos between healthcare and social care as well as other public services.
  2. Free personal care needs to be properly grappled with and implemented carefully.
  3. Services should be allocated by need, regardless of age.
  4. Patients with Alzheimer’s Disease (AD) should be clinically assessed, just as those with learning disabilities are clinically assessed.
  5. A comprehensive care workforce strategy needs to be implemented at a national and local level.

Read the full report here.

#ACJInsight #ACJSocial