Social careOct 13 2021

Social care creativity 'crushed' by govt top-down approach

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Social care creativity 'crushed' by govt top-down approach

The government's top-down approach to social care reform has “crushed” the creativity needed to form a more streamlined later life care industry, according to Alison Hesketh, managing director of consultancy TimeFinders.

On a webinar hosted by Sheffield-based law firm Irwin Mitchell yesterday (October 12), Hesketh said there were many examples of creative solutions to cost saving in social care provision which must not go unnoticed. 

She cited cost-saving exercises demonstrated by both the NHS and local authority care providers working together during Covid-19 to ensure people didn't go into hospital unnecessarily, and that they were only given care when they needed it.

“That best practice needs to be shared, because it's brilliant. And the key is that you've had some local leaders who've stood up and got things going,” she said.

“But if we start looking to the government to do its top-down approach, it's simply not going to work. We've got to find leaders in the community.”

She argued “some of the creativity is being, and has been, lost” by the government’s top-down approach to social care, resulting in key workers left out in the cold - either not listened to, unsupported, or both.

One example cited by the panel was the government’s new ‘Discharge to Assess’ scheme, designed to refer older, frail patients to care homes to free up hospital beds.

“What has been devastating about the way this has been handled is that families were led to believe that their care was being paid for. But actually, it was not a limitless pot,” Shaleeza Hasham, a fellow panel member and communications head at Surrey-based care home provider CHD Living, explained.

“The operator has been left [with this], having to sit down with families and have a very, very difficult conversation about what comes next. And this has been awful.

“To sit down with a family and say: ‘Right, I'm so sorry, the local authority is no longer going to pay for your care, so it is now going to cost £1,500 pounds a week for you to stay in this home. Or maybe we can reduce it a bit with a different bedroom, or a different location.' It's just not right.”

Hesketh said: “Creativity has been crushed by this top-down management approach. Carers know what they need to give. Carers know how they need to give it. So let's listen to them.”

Selling home not ‘unreasonable’

Along with the rest of the panel, Hesketh aired concerns over the government’s funding commitment to social care and the NHS in the form of a new 1.25 per cent social care levy and an equal rise in dividend tax, which it has estimated will total £12bn a year.

“I'm desperate that the funding doesn't get swallowed up in bureaucracy and middle management. It's got to go to the frontline, which is doing their very best and not wanting to pull the rug under people's care,” she said. 

She argued creativity around cost-saving in the social care sector was especially important as even with the government’s funding promise - however it’s distributed - this was unlikely to be enough.

“There has to be a massive education campaign,” she explained. “We all have to take some responsibility for our own health and welfare, and for our future planning.”

She continued: “I think as a society, we have become complacent - thinking that somebody else somewhere is going to pick up the bill. And I think we have to be really realistic about the fact that there isn't enough money to do that. We need to make sure that [funding] goes towards the most vulnerable.”

One example she uses is the promise made by the government, that people won’t have to sell their homes to pay for care.

“No, you probably won't, but you will probably need to sell your house to pay for your accommodation, if you move into residential care,” she explained, pointing to the fact the social care cap of £86,000 covers care only, and not hotel costs.

“I think it's disingenuous,” she said, before adding: “[Selling your house] is not necessarily entirely unreasonable. Why should the taxpayer pay for somebody to have two homes?”

She continued: “When you consider that with some of our clients who are in residential care, a third of the fee that they pay each week is classed as paying for care, whilst two thirds is paying for their hotel and their accommodation.”

Family carers

Faith Salih, a third panelist and associate solicitor at Irwin Mitchell, criticised secretary of state for health and social care Sajid Javid for his comment at the Conservative Party conference that health and social care “begins at home”.

“Those comments are unlikely to have reassured gratuitous carers [i.e. relatives looking after family members],” said Salih.

“They're already propping up the system. They have been for years. They're under recognised and unsupported.”

Stewart Stretton-Hill, the final panellist and a senior associate at Irwin Mitchell, said “a firm commitment” of where the government’s social care fund is going will be important, with many fearing the majority will go to the NHS.

“The proposals haven’t touched on gratuitous care, which sees family members looking after relatives and losing out on incomes or jeopardising pensions - which is simply perpetuating the social care crisis.”

He suggested the government introduce tax incentives or interest-free loans to provide relatives with the support they need.

“This will support them back into employment, versus forcing them to prop up the system.”

A Department for Health and Social Care spokesperson said: “We want to deliver world-leading social care across the country and investing an additional £5.4bn funding over the next three years will allow us to begin a comprehensive programme of reforms for adult social care.

“We are committed to improving information for the public to help them navigate the care system and will work with care users, providers, and other partners to develop our plans on social care reform.”

ruby.hinchliffe@ft.com