‘How can social care evolve to support greater integration with health services?’

Social care can no longer be the handmaiden to the NHS. This was the clear message given at a feisty meeting of the Cambridge Health Network, which took place in London on July 21st 2015. Speaking about the challenges were Andrea Sutcliffe, Chief Inspector of Adult Social Care from the CQC, Ray James president of the Directors of Adult Social Care, and Ian Smith, chair of large care home chain Four Seasons Health Care.

Perhaps the most shocking stat of the evening was Smith’s assertion that he currently has 2000 empty beds across his estate. This at a time when hospitals are full to bursting with patients, insultingly called bed blockers, who would get better care within a nursing home. The problem seems to be funding. ‘Until money follows the patient, we will continue to be in this situation’ Smith told the meeting. Four Seasons would need less than £800 per patient per week to fill these beds, and although this is considerably less than an inpatient stay in hospital (which can cost the taxpayer as much as £3,000 per week), the NHS has protected funding whilst the social care sector does not.

James told the meeting that social care funding has fallen in real terms by 31 per cent whilst NHS budgets have been ring fenced. He also noted the scale of the care given with a workforce of 1.5 million (rising 2.2m in 2025) and agreed with Smith that capitated budgets straddling the health and care system, and at scale, not just in pilots (or Vanguards) would be a much better solution.

Smith came armed with a manifesto – eight recommendations he believes need to, and crucially could, happen now to fix a broken system. This included reducing a heavy burden of regulation by transferring all responsibilities to the CQC.

Sutcliffe has been chief inspector for about 18 months and has a well thought through vision of what her role should be. It centres around a simple but compelling proposition ‘Would I want my mum to use this service?’ Her team inspect services against five questions – are they safe, effective, caring, responsive and well led? They also have a new market oversight responsibility to spot whether another Southern Cross situation might happen so appropriate action can be taken to protect continuity of care for people.

Sutcliffe agreed with James and Smith (whose company bailed out some of the stricken homes in 2011), who were unsure that the market would react again in the same way.

Economics was not far from people’s mind as the session opened up to questions. A fascinating discussion on unintended consequences of the minimum wage hike ensued. Four Seasons will of course implement this, but possibly at their cost as funding is not increasing along similar lines. This is an industry close to the edge, and one we will all need to experience for family and in time ourselves.

One questioner said he thought this was one of the best CHN meetings to date, but lamented a smaller audience than usual with less NHS colleagues in the room. ‘Although the CHN is attributing this to summer holidays, it might be that they don’t realise how relevant this is’ he espoused.

In her concluding remarks, CHN co – chair Pam Garside pledged to re-run the session in some form in the future to a more diverse audience.  ‘The sector is in peril’ she said ‘we need you three (the speakers) in charge.’  Few who attended disagreed.

The speakers have kindly agreed to share the slides from the session. Please view them below:

Andrea Sutcliffe, CQC, CHN presentation

Ray James, ADASS, CHN presentation

Ian Smith, Four Seasons Health Care, CHN presentation