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10 November 2017updated 09 Sep 2021 4:37pm

A warning worth heeding: why health and care costs need to be integrated

It's not a case of either/or. Health and care both urgently need investment in the Budget.

By Caroline Abrahams

This week, Simon Stevens, chief executive of the NHS, has called for more funding from the forthcoming Budget, warning that without it the quality of healthcare available to us all is sure to suffer. 

His is a call that Age UK supports. The numbers speak for themselves: the NHS is experiencing a degree of sustained belt-tightening that is unprecedented in modern times; this while an ageing population is inevitably increasing the demand for services. 

From an Age UK perspective, we worry a lot about the impact of this stress in the system on older people, for whom the ability to get the right treatment and support quickly is hugely important – whether it is to help them sustain good health and wellbeing or because they have health and care problems that need to be addressed. 

Some policymakers have argued that if only the NHS and social care were better joined up, or integrated, then this would mean money was better spent – that effectively the problem isn’t a shortage of funding but one of inefficiency and waste. 

No doubt there is always scope for improving the productivity and efficiency of all services, the NHS and care included. However, there comes a point when insufficient funding not only compromises the quality of services on offer – and access to them too – it also actually discourages professionals and organisations from working together across the healthcare interface.   

The conventional counter argument is that “a burning platform” such as that offered by the dire finances within both health and care at present is a wonderful incentive for everyone to come together for the greater good – with the shortage of funds forcing managers to pool risk and money in a way they may have resisted before.

However, this strikes me as hugely over-optimistic because there is a contrary tendency for organisations under pressure to retreat and protect what they have. Rather than nobly overcoming boundaries people patrol them all the more diligently.

I’ve seen this for myself while supporting my mother through the health and care maze. A trivial but striking example comes from a phone call I had with the member of her council’s Adult Social Care team a few weeks ago over whether she was entitled to have some grab rails fitted in her home. 

After a 20-minute “assessment” I was told that the decision of her local authority was that she wasn’t eligible. The reason was that the council’s role was to fit grab rails for the purpose of aiding safe transfers – e.g. between a bed and a chair, whereas if the grab rails were required to aid mobilisation then that was the job of the NHS. Since the rails were to go over two radiators, due to my mother’s propensity to hold onto them while moving around, thus risking a burn when they were switched on, her need fell into the second category and was thus the job of the NHS. 

It struck me that this was a rather absurd differentiation and that it probably cost more for the staff member to go through the process of deciding my mother was not eligible for this particular service than it would have done simply to install the rails! 

In addition, I was not told how to go about approaching the NHS to pursue them meeting my mother’s needs: it felt like the staff member thought they had done their job by simply diverting this particular request for help away – no doubt one of many that day. 

This is a trivial example of a problem that seems widespread. A survey of social workers carried out this summer by the Care and Support Alliance and Community Care magazine threw up numerous similar examples of council staff being told to direct any need for help onto the NHS – or somewhere else – if it could conceivably be argued that there was a valid reason to do so. I recall, for example, one respondent saying they had been told to inform a person with MS that they could not use their personal care budget to pay for transport to a local MS support group because that was a health rather than a care need. 

This is the sad and rather ridiculous position we seem to have reached in our health and care services; where more effort is sometimes being expended on pushing people away than on meeting their needs. It goes without saying that this is the antithesis of what the NHS and social care exist to do, and what the people who work for them want to do – another reason why we hope the government heeds  Mr Stevens’ call and invests more money in health and care in the Budget in two weeks’ time. Truly, we can’t go on as we are. 

Caroline Abrahams is charity director at Age UK and co-chair at the Care & Support Alliance.

Caroline joined Age UK in 2012. A social scientist and barrister, Caroline has spent her career in the voluntary and public sectors, mostly on children and families’ issues. She has worked in a senior capacity at the children’s charity, Action For Children and at the Local Government Association. Caroline has also been a policy adviser to Ministers and Shadow Ministers, and a senior civil servant. A former chair of the End Child Poverty campaign, Caroline’s policy interests include integrated health and care, family policy, poverty and the role of the voluntary sector.

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