Many people will, at some point in their lives, require care and support either from family and friends, or from the formal care sector. It comes as a great shock to many people that whilst the care and treatment provided by the NHS is free, care services (like help with washing or preparing food at home), are means tested and many people will have to pay for them.
The NHS, social care and social housing are most frequently used by older people, and these older people often have several needs at the same time; a need for NHS care from their GP and a specialist for a long-term condition like diabetes, a need for help with washing, dressing or getting around that is often provided by their council, and a need for housing that keeps them warm and well.
The best test of such complex services is whether they work well together from the point of view of the older person, or whether they provide care and support in the most effective and efficient means possible, from the point of view of the public purse. The Committee has come to the view that these separate systems are inefficient and lead to poorer outcomes for older people. Indeed, trying to define NHS care and social care as two separate and distinct things will only make matters worse for older people.
We have spoken with people who use and work in the services of Care Trusts, some of the most integrated organisations in the country, and heard evidence that integration can prevent hospital admissions and support the independence of older people. Such organisations do this better, at least in part, because they have a single pot of money from different sources to deploy in the manner that best meets people's needs. Although the Government has "signed-up" to the idea of integration, little action has taken place to date. The Committee does not believe that the proposals in the Health and Social Care Bill will simplify this process.
The Committee recommends that, whilst integration is not an end in itself that it can be a very powerful tool to improve outcomes for older people and people with disabilities and long-term conditions. To that end, each area should establish a single commissioner who will bring together the different pots of money that are spent on older people. This single commissioner could then best decide how this resource should be deployed in order to improve outcomes for older people. A similar task needs to happen at the national level, with the Government coordinating policy and regularly rebalancing spending across health, housing and care services. The Government should also develop a single outcomes framework for older people to replace the three overlapping but confusing frameworks that currently exist.
In order to achieve the level of integration that is required, a number of steps need to be taken. The Government must face the issue of the existing "funding gap" in social care services i.e. the gap between the number of people who need care (and the level of their care need) versus the amount of money that is currently in the system to deal with their needs, The Government will also need to outline its proposals for responding to the Dilnot Commission on how the individual contribution to their care costs can be made in a manner that is fair and equitable. It is essential, however, that services are shaped by the objective of providing high quality and efficient care delivery, and the funding structures are fitted around that objective, not vice versa.
The millions of informal carers in England must also get a better deal. Despite the clear case for supporting carers to continue to care, the majority are not being identified, assessed or offered support. The Committee is clear that a new offer needs to be made to older people. A new, integrated legal framework is required which supports integration of health, social care and other services around the needs of the individual.