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  • Writer's pictureTeam Nellie

1.2 million older people not having their assessed needs met in the UK.

Updated: Sep 22, 2023

Adult Social Care: how do we fix it?

Adult social care is a troublesome area and will continue to be for many generations, we are living longer which in turn is leading to an increase in age-related illnesses such as dementia, quite simply put the client base is growing.


Regardless of what is said its all about the money, part of the issue is that we don’t pay domiciliary care workers well enough. They work a large number of hours working in some cases with complex cases involving hoarding, self-neglect and difficult behaviours and work unsociable hours.

We don’t train enough professional staff, including social workers, occupational therapists and nurses, and the media portrays any health and social care role as a difficult, draining and tiresome job. Anyone that has watched Kiri, or even Dammned would not see social work as a  positive career choice. To help matters the government have also cut funding for nursing and social work training (bursaries) and there has also been an increase in tuition fees which makes training in one of these roles less and less attractive.


So we have poorly paid staff at one end a lack of staff at the other end and to help things along a mass of red tape with the NHS and Local authorities squabbling over budgets and responsibilities.

This all results in the conveyor belt seizing up, patients can’t leave hospital because there’s not enough qualified staff to complete assessments (a freedom of information request to Cambridgeshire County Council showed 520 individuals were awaiting assessment as of March 2018), when the assessment is completed there is a lack of domiciliary care available to meet needs at home quickly, from experience I have known people waiting several months for care packages to be picked up by care providers. This then, in turn, results in the being moved from hospital to a care home into a “deficit bed” which can, in some instances, disable an older person the end result is that when a home care package is finally available their needs have increased and they are unable to return home.


Now before people start saying there are loads of domiciliary care providers out there…your right there are. But most local authorities have a cap on the hourly rate they will pay a care provider, others will only work with care providers they are contracted with. So if these limited care providers have no availability. Your stuck waiting.


To make things more complicated nursing and residential homes are paid a low rate (approx. £435 per week) to provide care. Now imagine finding a good hotel that is all inclusive for £435 a week and then sees if they will also be able to provide staff 24 hours 7 days to meet all of your personal care needs?


The answer the nursing homes have come up with is third party top-up fees. This way they can charge a higher fee, for this arguments sake let’s say £1000 per week, and the additional £565.00 would need to be paid by a third party, i.e son or daughter. Now paying £565.00 as a one-off might be possible for some people, paying it every week for an indeterminate amount of time is a different matter.


So if you’re in the hospital, and you can’t find domiciliary care and your family can’t afford a third party top-up fee, then you’re stuck waiting for a care home that accepts the local authorities rate.


So that’s some of the problems, but not all of it.


Now if you need more complex support, i.e from a mental health specialist nursing home, in such cases as those that display aggressive behaviours, that creates a whole new delay as specialist support needs to be found and the cost of who is going to pay for it argued out between local authorities and the NHS. But finding a bed in a specialist unit can take months, and mean a person is placed miles from their home and family.


If you’re under the financial threshold of £23,250.00 then your local authority will pay TOWARDS your care costs, but their caps and restrictions (mentioned above) will have an impact on your care provision.  If you have savings or income over that threshold then you’re paying for it yourself, and in some cases organising it for yourself.


So how do we fix it? ( I know I’ve asked this once already)


Jeremy Corbyn believes a national care service is an answer, to create a genuine cradle to the grave health and social care service. If this had been put into place along with the inception of the NHS in 1948 then it may have been more possible, in 2018 I am not so sure how much of an appetite the general public has for another free at the point of access service. It’s a strange conundrum, no one appears to want to have to pay for care when they need it but then no-one wants to pay for it before they need it.


Im not quite sure what the government of the day believes, I’m not sure they know what they believe.


Personally, I think a social enterprise or socially ethical business model is a more modern way of moving forward, by those that can afford to pay for care paying form turn reducing pressures on the NHS and local authorities, reducing spending and workloads of statutory services.

But we are on a crux, in the coming years, there is a genuine risk of seeing an influx of American health and social care services to the UK, once they have established it will be difficult to change the ethos of how care is provided. The majority of health and social care professionals in the UK chose their professions because they want to help, their neighbours, communities and their friends.

If we need to pay for health and social care, then we need to ensure it is caring professionals that are leading the way rather than anonymous corporate America.

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