The health and social care crisis

The Care Funding crisis has been a topic of debate for quite some time. Despite the government’s commitment to ‘put the state-funded system on a more secure and sustainable footing‘, extensive media coverage and various reports, effective progress towards tackling our overburdened health and social care system remains to be seen. The pressure is caused by:

  • The rise in patients seeking treatment for mental health issues. Waiting time for an appointment with children’s and young people’s community services has risen from 11 weeks in 2012/13 to 26 weeks in 2015/16. The total number of annual Mental Health Act 1983 detentions has risen by 26% between 2012/13 to 2015/16.
  • An ageing population. Worryingly Age UK estimates that 1.2 million older people are left to struggle each day without care and support.  The number of people aged 85 or over in England is set to more than double over the next two decades.
  • The number of working-age adults with long-terms needs has increased.
  • Difficulty in recruiting and retaining staff to care for people. In 2016/17, the overall staff vacancy rate across the adult social care sector was 6.6%, rising to 10.4% for domiciliary care staff. The staff turnover rate in 2016/17 was 27.8% (an increase on 4.7% since 2012/13).

The Care Quality Commission has warned that ‘the entire health and social care system is at full stretch’ adding that ‘The impact on people is particularly noticeable and social care is approaching a ‘tipping point’ where deterioration in quality will outpace improvement and there would be a substantial increase in people whose needs are not being met’.

Similar concerns have been raised by the House of Lords Select Committee on the Long-term Sustainability of the NHS and Adult Social Care. ‘Our NHS, our ‘national religion’, is in crisis and the adult social care system is on the brink of collapse’. Is the NHS and adult social care system sustainable? Yes, it is. Is it sustainable as it is today? No, it is not. Things need to change’. The Sustainability Committee identified an urgent need to rethink the current approach, indicating that in the long term, the focus must be on the delivery of an integrated health and social care system.

A huge problem is caused by the ‘over-reliance on the acute sector. A&E Departments and their facilities are being overwhelmed by patients with long-term care needs that are not being met by Community services‘.  

Often patients with long-term care needs, such as assistance with daily living activities, management of complex healthcare needs, or mental health aftercare support needs, are admitted to Hospital for treatment and their discharge is subject to significant delay.

In 2016/17, the national daily average rate of delayed transfers of care was 14.9%. The largest increase was seen in delays due to patients awaiting residential home placement or availability, increasing by 68% from 2015/16.  

The transfer of care is delayed because of:

  1. Disputes over funding. Many patients are not routinely assessed for NHS Continuing Healthcare, Care Act 2014 or s.117 Mental Health Act 1983 aftercare funding in contradiction to the applicable guidance. Those who are assessed, routinely find assessment processes are fundamentally flawed and funding is often not awarded to patients who are in fact eligible.
  2. Difficulties with the negotiation of and agreement to a care package. Clinical Commissioning Groups and/or Local Authorities often do not engage in the care and support planning process effectively, and patients often struggle to achieve a care package which meets all their identified needs.
  3. The lack of available social and nursing placements.

The Government has committed to the publication of a Green Paper on ‘Care and Support for Older People’ by summer 2018.  It is doubtful, however, that this will result in the urgent action required to tackle the severity of the current crisis.

As officials continue to debate the long-term sustainability of the NHS and Adult Social Care system, individuals and their families should be aware of their rights throughout the Hospital Discharge and Care Planning process. The eligibility criteria to quality for NHS Continuing Healthcare, Care Act 2014 and s.117 Mental Health Act 1983 funding, and the processes which should be followed to determine eligibility are clearly detailed in a complex web of legislation.

The ability to obtain care and support will increasingly require detailed knowledge of complex legislation, the logical presentation of evidence to demonstrate a person’s care needs against the eligibility criteria, and experience of how to navigate various assessment processes.

We specialise in assisting individuals or their representatives with all aspects of health and social care matters to ensure that they are not left without appropriate care and support.