The NHS is in crisis. Social care is in crisis. And, in so many ways these crises seem to be reinforcing each other. For many successive years, NHS staff have been warning that an increasing number of patients remain in hospital because there are insufficient care provisions for them to be safely discharged (either to their own homes or a residential facility). In September 2024 an independent investigation into the NHS concluded
“Ministers must recognise that investing in and reforming social care is not just a separate issue. it is integral to the survival and success of the NHS. Right now, 13% of NHS beds are occupied by patients awaiting social care support.”[1]
To me personally, the distinction between social care and healthcare is difficult to define. When is the help an individual requires classed as social care rather than medical care? When the help could be given by someone without medical training? When it is carried out in a person’s home rather than a hospital?
But maybe a more important question is why separate health and social care at all? Even when care is medical in nature e.g. a surgery is carried out, without what might be classed as appropriate social care (e.g. someone to ensure the healing surgical wounds are kept clean and free of infection, someone to make sure the convalescing patient is able to stay adequately feed and hydrated) any potential improvement to the health of the patient will quickly be undone.
When it comes to funding health and social care, the difference is stark. The NHS is (currently) free at point-of service but funding for social care is much more difficult to obtain. With care packages after being discharged from hospital limited to only a few weeks, those with complex and long-term needs can face bills of hundreds or even thousands a week to meet their needs and it has become increasingly common for almost all the savings and assets a person accrues in a lifetime being used to trying to pay for nursing home fees or other care in the last few years of an elderly person’s life.
As with so many crises, warnings have been issued for many years that this situation was inevitable. People were living longer making it much more common for elderly people to spend years unable to look after themselves without help. Advances in medical treatment meant that younger people with conditions that might well have been fatal in previous centuries now survive and can lead long lives (assuming they get an adequate level of help). And then came years of underfunding of both the NHS and social services and a pandemic.
But one of the most bizarre aspects of the healthcare/social care crises is continuing health funding.[2] Strangely, a substantial proportion of money is already allocated in the NHS budget to care for those whose ongoing care needs are deemed medical in nature. Except this funding often remains unknown to health professionals and has a reputation for being incredibly difficult to secure. In light of the crises facing both the NHS and the social care system, is it not time to try and make this funding more widely understood and easy to access?
At the time of writing, I am currently going through the process of trying to secure continuing healthcare (CHC) funding for an elderly relative. Even with a huge amount of help the process has been difficult, which is why I am currently trying to arrange meetings with MPs, local government officials and non-profit organisations to try to make more people aware of this funding and to help inform care providers about the type of records and evidence they might need to show in order to make a successful case.
Watch this space…
[1] https://www.careengland.org.uk/the-lord-darzi-report-urgent-action-needed-to-address-social-care-crisis-and-alleviate-nhs-pressures/
[2] https://www.nhs.uk/conditions/social-care-and-support-guide/money-work-and-benefits/nhs-continuing-healthcare/