Better integration of health and social care needed as 'perfect storm' hits industry, say experts

On Monday, the BBC reported that social care contracts at 95 local authorities in the UK had been cancelled by care providers in light of cost pressures in providing care services. According to the BBC's report, 69 home care providers have exited the market in the last three months and a quarter of all such providers in the UK are at risk of insolvency.

Health and social care experts Joanne Ellis and Sean Elson of Pinsent Masons, the law firm behind Out-Law.com, said the report, together with the recent sale of Mitie's home care business for just £2, highlights the difficult financial environment in which local authorities and care providers are operating in. They said that a high-turnover of staff and shortage of skills is a further problem providers are having to manage.

A move towards more integrated health and social care provision is needed to help address the problems, they said.

"The financial pressures in the care market are well-publicised and stem from a range of factors," Ellis said. "The UK's population is ageing, putting pressure on both the NHS and social care sector to deliver services. However, local authority budgets are tight, and social care providers are also subject to the National Living Wage requirements on worker remuneration."

"In addition, care providers are under pressure to increase the amount of time that carers spend with each person receiving home care, and cost pressures also arise from the fact that an HMRC crackdown aimed to ensure that care workers are paid for time spent travelling between appointments and not just for time spent delivering care. Care providers can look for efficiencies, however, not at the cost of quality care. The quality of care carers provide is the subject of unprecedented scrutiny following cases in which bad practices were highlighted, while tougher sentences are available for those that engage in criminal wrongdoing," she said.

Elson said social care providers are being asked to provide a high and broad level of care under severe financial pressures and that the business model for many is no longer sustainable.

"In addition to the financial pressures in the market, care providers are also battling with a high turnover of staff that they spend a lot of time and money in delivering training to, in a kind of 'perfect storm' impacting on those businesses," Elson said.

"The work of carers is undervalued and stigmatised. Workers receive modest pay and there is not always a clear career pathway for those that deliver care services. In addition, the image of the work done by carers is influenced by media coverage that tends to focus on cases of abuse and use of zero-hours contracts rather than the first-class attentive care delivered by the vast majority, so the attractiveness of the role as a career option is diminished in the eyes of the public, in contrast to the perception of the similar work nurses do in hospitals, for example. A further pressure on filling care worker roles in future could also arise if new immigration controls are in place as a result of Brexit," he said.

A rethink is needed on how social care is linked into the provision of health care, how it is paid for, and how it is promoted, Ellis and Elson said.

"For many local authorities and care providers, the current model of delivery is unsustainable," Ellis said. "The chancellor, in his recent Budget, pledged an extra £2 billion for social care, but throwing more money at the problem alone will not solve the long-term challenges in the market."

"The UK needs to get better at managing issues facing the elderly before they become major problems that require intervention by the NHS, and to ensure NHS patients receive necessary assistance at home after they are discharged from hospital. There needs to be greater integration, therefore, between health and social care services. An open mind is needed on how that should be paid for," she said.

The idea of a dedicated health and social care tax has been mooted. Elson said questions of finance should, however, be tied to changes in delivery model.

"At the moment, it is commonplace for families to foot the bill for childcare costs in most instances, yet there is an expectation that the state will pay for the cost of the elderly in society in the form of health and care services," Ellis said. "It would be difficult politically for a government in the UK to challenge that expectation and reform the model of delivery and way in which health and care services are paid for. However, it is clear that the status quo is unsustainable."

Technology can play a role in helping to integrate the health and social care sectors, Ellis said. Some care providers already use devices such as iPads and social networking tools to keep in remote contact with people they deliver care services to, and monitoring technologies and alarms are also in use to help alert care providers to cases where emergency care is required, she said.

"Remote contact should not be a substitute for personal contact," Ellis said. "However, health and social care providers must keep an open mind on how technology can help augment the services they deliver."

Elson said: "Artificial intelligence (AI) may have a role to play in future in delivering at least some of the care and contact services delivered by care providers."