Why much more must be done to save social care

Care work­ers earned our admi­ra­tion and grat­i­tude for the way they respond­ed to the coro­n­avirus emer­gency, often putting their own lives at risk to pro­tect our loved ones. The pan­dem­ic laid out in stark relief just how crit­i­cal social care is to com­mu­ni­ties, to the econ­o­my and to the NHS. 

But the harsh real­i­ty is that work­ing in health and social care is still seen as unap­peal­ing. The care sec­tor entered the pan­dem­ic in a dif­fi­cult posi­tion, with acute staff short­ages, poor work­ing con­di­tions, low morale and a lack of invest­ment in build­ings and tech­nol­o­gy.

The COVID-19 death toll in care homes was shock­ing. The ques­tion is whether the pan­dem­ic will bring stake­hold­ers togeth­er with a new sense of urgency to address these deep-root­ed issues.

The future of the care sec­tor is shroud­ed in uncer­tain­ty by repeat­ed delays to social care reforms, includ­ing the way in which it is fund­ed. Relat­ed to this are the finan­cial prob­lems of many of the pri­vate providers in the care sec­tor. A num­ber of the biggest care home com­pa­nies require finan­cial recon­struc­tion while many fam­i­ly-run busi­ness­es are strug­gling to stay afloat.

While the NHS has expe­ri­enced sig­nif­i­cant staffing pres­sures, the issues in social care are even greater and the out­look is a con­cern. One mea­sure of the work­force sup­ply gap is the vacan­cy rate. This rose from 5.5 per cent in 2012–13 to 7.8 per cent in 2018–19. In Lon­don it was 9.3 per cent, mak­ing it the region with the high­est rate. The num­ber of vacan­cies in social care in Eng­land is esti­mat­ed to aver­age 122,000 at any one time. 

Supporting vulnerable people increasingly hard

Staff short­ages have been exac­er­bat­ed by uncer­tain­ties over Brex­it, with many care work­ers in the UK orig­i­nal­ly from Euro­pean Union coun­tries and unsure about their future sta­tus, which makes work­ing in health and social care even more pre­car­i­ous.

Mea­sur­ing the full impact is dif­fi­cult because of the dis­rup­tion to trav­el caused by the pan­dem­ic, but the sec­tor remains suf­fi­cient­ly alarmed to press the gov­ern­ment for urgent clar­i­fi­ca­tion about what will be done to ensure the elder­ly and vul­ner­a­ble peo­ple are not left with­out good care because of the deep­en­ing skills short­age. Uni­son, the union, has called for an urgent review of pay and con­di­tions in the social care sec­tor.

One of the lessons of the pan­dem­ic has been the extent of mutu­al depen­dence between the NHS and social care. When the care sec­tor fails, the NHS is put under addi­tion­al pres­sure and vice ver­sa.

The NHS Long Term Plan for Eng­land, pub­lished last year, puts sig­nif­i­cant empha­sis on sup­port­ing more peo­ple in the com­mu­ni­ty. But this is only pos­si­ble if peo­ple are will­ing to work in the health and social care sec­tor, sup­port­ed with the train­ing and the tech­nol­o­gy they need.

This is not just about how we look after peo­ple as they become old­er and frail­er, but about peo­ple of all ages who live with long-term con­di­tions that require care and sup­port. And it is about men­tal health as well as phys­i­cal health.

Joined-up health and social care is vital

Tech­nol­o­gy can pro­vide some of the answers. Since COVID-19, health­care organ­i­sa­tions have been mov­ing ser­vices online at a dra­mat­ic pace. The most obvi­ous impact has been to reduce the num­ber of phys­i­cal vis­its to the GP and hos­pi­tals. But behind the scenes, dig­i­tal tools have been used to bring dif­fer­ent ser­vices togeth­er across pri­ma­ry care, com­mu­ni­ty ser­vices, hos­pi­tal ser­vices and social care to work togeth­er to deliv­er joined-up care.

Inno­v­a­tive tech­nolo­gies have also enabled team­work­ing among much broad­er net­works involv­ing fam­i­ly mem­bers, peers and local com­mu­ni­ties, allow­ing par­ents to mon­i­tor their children’s health while at school or patients to cre­ate sup­port com­mu­ni­ties includ­ing their peers, vol­un­teers and friends.

Clin­i­cal teams need new path­ways and new ways of work­ing if we are to deliv­er high-qual­i­ty proac­tive care to our patients in this new world

The coro­n­avirus out­break has high­light­ed how woe­ful­ly inad­e­quate paper process­es are for the care sec­tor, par­tic­u­lar­ly at a time when the risk is chang­ing hour by hour. By dig­i­tal­is­ing care-plan­ning process­es and evi­denc­ing care using mobile tech­nol­o­gy, providers can make time effi­cien­cies that empow­er car­ers. Not only can care evi­denc­ing apps save car­ers time, they also give them the tools they need to do their job. They pro­vide reli­able reminders, high­light con­cerns and enable car­ers to mon­i­tor res­i­dents’ well­be­ing.

Icon-dri­ven apps that evi­dence care at the point of care have been shown to save each car­er up to an hour a day in paper­work. With almost 1.5 mil­lion peo­ple work­ing in social care, such addi­tion­al capac­i­ty would be trans­for­ma­tion­al.

Tech alone is not enough

Bet­ter still, the insights gen­er­at­ed by dig­i­tal sys­tems can cre­ate an envi­ron­ment of con­stant improve­ment by high­light­ing where pro­vi­sion needs to be devel­oped, and iden­ti­fy­ing trends across all areas of res­i­dent well­be­ing from sleep, nour­ish­ment, hydra­tion and med­ica­tion to exer­cise and men­tal stim­u­la­tion.

But tech­nol­o­gy alone will not pro­vide all the solu­tions. Sys­temic change is need­ed. Dr Matt Kear­ney, GP and pro­gramme direc­tor at UCLPart­ners, says: “Tech­nol­o­gy will be a key enabler, but clin­i­cal teams will need new path­ways and new ways of work­ing if we are to deliv­er high-qual­i­ty proac­tive care to our patients with long-term con­di­tions in this new world.”

Sal­ly War­ren, direc­tor of pol­i­cy at the King’s Fund health and care think tank, con­cludes: “Too often, politi­cians of all par­ties decid­ed they couldn’t afford the polit­i­cal cap­i­tal and the finan­cial cost of social care reform. We can only hope the cur­rent cri­sis is show­ing they can’t afford not to.”

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