The new Centre for Progressive Policy (CPP) report, Diagnosis Critical: launching an inquiry into health and social care in England, shows that the decline in public expenditure on social care is impacting the NHS’s capacity to respond to increased demand whilst itself experiencing a slowdown in funding growth. In particular through:
People going straight and repeatedly to A&E because they cannot access the support they need within their communities. Most of these people are elderly who account for a fifth England’s population, but a third of A&E re-attendances. Data on unplanned hospitalisations for chronic ambulatory care sensitive conditions (ACSC), where effective community care could have prevented the need for hospital admission, allow show that after a period of structural decline from 2004 through to 2009, the number of unplanned ACSC hospitalisations went into a period of structural growth from 2010 onwards, from around 106,000 in 2009 to 111,497 in the first quarter of 2017.
People spending longer periods in hospital because they cannot be discharged into local residential facilities or access suitable domiciliary care. Data on ‘delayed transfer of care days’ (DTOCs) attributed to social care allow us to examine this second channel. DTOCs attributed to social care occur when, for example, a patient who is ready to be discharged is still occupying a hospital bed because they are awaiting availability in a care home. Social care DTOCs as a percentage of all DTOCs rose from an average of 26% in 2014 to one of 36% in 2017 (fig. 9). While there is evidence that the tide began to turn in 2017, supported by a £1bn investment made in social care that year to prevent further deterioration in social services, there is a long way to go from emergency capital investments. A further CPP analysis shows that rising social-care DTOCs are exerting financial pressure on NHS trusts.
Given both health and social care are underfunded, the government’s emphasis on the integration of the two services will struggle to relieve the financial strain on the NHS. In this respect, CPP’s new report argues that we must look beyond the traditional confines of health and social care to integration of mental, physical and public health programmes within wider social and economic policy.
A move away from remedial thinking towards preventative thinking – often said, but rarely done – is the first condition for reform.
Over the coming year, the CPP’s inquiry into health and social care in England will join others’ efforts to tackle the broader social determinants of health (e.g. Health Foundation) as part of, rather than peripheral to, health and social care system re-design and how it can change from a system mainly set up to treat disease when it arises to one that is mainly set up to maintain health over the course of a lifecycle.