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How will the government’s health and social care ambitions impact on care homes?

The government is currently making plans to fulfil one of its flagship manifesto pledges, namely to integrate health and social care services in a more 'joined up' approach.

Health Minister Jeremy Hunt has vowed to bring about "a step change in services offered through GP surgeries, community care and social care" and his comments have been broadly welcomed by a wide range of health and social care providers.


Hunt's new initiative, known as the Better Care Fund, is being trumpeted as the solution for a range of issues (including bed-blocking by elderly patients) that have long bedevilled the NHS and social services. In support of this initiative the Government has committed to transferring £3.8 billion from NHS budgets to facilitate joint NHS and local council decisions about how these services will be funded.

It sounds generous but this is not 'new' money. The funding is already committed to current core activities; it's simply being redistributed. What's more the NHS and Local Government Association both agree "the fund does not in itself address the financial pressures faced by local authorities and CCGs in 2015/16, which remain very challenging".

The next round of austerity cuts being prepared by government in order to 'balance the books' will put additional pressure on a sector that has already suffered dramatic reductions in its funding over many years. Age UK found that in 2012 alone spending on older people's care decreased by over £300 million and its data for 2012/13 and 2013/14 shows an even steeper decline in annual funding levels.

Overall, the charity has calculated that money spent in real terms on elderly care has decreased by at least 10 per cent since 2010. Some of the areas most affected have been community services such as day care centres and home support services and this has led to a situation where vulnerable older people are forced to look after themselves, leading to more emergency hospital admissions when accidents inevitably occur.

In its "Care in Crisis" report 2014 Age UK states: "The Government's aspirations to 'transform the social care system to focus on prevention and the needs and goals of people requiring care' cannot be achieved. Indeed the use of funding is going in the opposite direction."

In the light of the cuts already made and those still to come - and bearing in mind that no additional funding is likely to be available, at least in the immediate future - the government's push for integration of services looks less like bold innovation and more like an attempt to take the heat off the NHS by transferring some of its key responsibilities to other bodies.

In the best case scenario, Better Care Fund discussions between NHS England and local authorities may eventually result in the reallocation or sharing of funds between the NHS and other bodies. However NHS funding is likely to come under even greater pressure in the next few years, so nothing can be guaranteed. The worst care scenario would be a restructuring of health and social care without adequate funding in place.

As the NHS moves to integrate with other services, local authorities and charities will find themselves on the front line and, along with them, the nation's nursing homes. Already set up to provide 24-hour nursing and social care and with trained staff able to support patients with Alzheimers and Dementia, residential care homes offer an attractive alternative to hospital care or expensive home support packages.

Jane Townson, Chief Executive of the Somerset Care Group, agrees that nursing homes can play a central role in the government's plan to integrate care services, but not at any cost. "Local authority fee rates for modern nursing home beds cover only about 70 per cent of the true cost of provision of nursing home care. Additional funding, either from local authorities or from the Better Care Fund, will be necessary if care providers are to play their part in reducing pressure on the NHS. Intermediate care services in nursing homes play a vital role in enabling more rapid discharge of individuals from hospital and helping them regain independence as quickly as possible. Additional beds and extra investment in staffing are required to deliver such services."

If the Better Care Fund is to deliver what its name suggests, then it cannot simply rely on spreading already overstretched budgets more thinly. Nursing homes are willing to play their part in Jeremy Hunt's pledge to revolutionise social care, but they can't deliver what the government wants without adequate funding and support.

By: Robert Anderson

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