Cradle to Grave
An FOI request from the Observer to the Care Quality Commission has revealed it was notified of 30,000 allegations of abuse involving people using social care services in the first six months of this year. Allegations ranged from physical, emotional and sexual abuse to financial fraud. The rate at which allegations of abuse have been made in 2015 is double that of 2011. In 2013-14, a professional carer was the alleged abuser in care homes in 57% of allegations. In people’s own homes, professional carers were identified as the abuser in a third of cases.
The CQC seems powerless to stop the flow of allegations it receives – 150 a day – and its chief inspector of adult social care, Andrea Sutcliffe, has publically blamed a lack of political leadership and huge cuts in funding. £4.6bn has been cut from social care budgets in the last five years. How to train, motivate, pay and retain a million care workers with less funding is unclear.
Poor care of the elderly gets most media attention because elderly patients are the main users of the NHS and social care. However, the greatest long term health benefits come from investing in the social care of the youngest. £377 billion a year is spent in the UK on social spending, including benefits and pensions, but only £12 bn on childhood interventions. The UK’s record on disease and deaths among under 5s is poor, and those that survive child poverty can have long-term health issues.
Children living in poverty in the UK are more likely to die in the first year of life, be born small, be bottle fed, breathe second-hand smoke, become overweight, perform poorly at school, die in an accident, develop chronic diseases, have a poorer quality of life and to die prematurely as adults. Investing in better health, education and social care for mothers of unborn babies and children up to the age of five has huge long term benefits in reducing physical and mental illness, family breakdown, drug use and obesity And yet this area is facing the biggest cuts.
Children’s health services are likely to be most affected by £200m cuts to local authority budgets in England by 2016, as NHS budgets for 0-5 year olds are transferred to LAs in October 2015. The Government has already ditched its child poverty targets, and cuts to tax credits and welfare spending are likely to make child poverty worse. Child poverty was assessed as the proportion of family households with an income below 60% of median income, which meant that 2.3 million children (almost one in six) are below the poverty line. Tony Blair’s commitment to eradicating child poverty by 2020 looks unlikely.
At the other end of life, Healthwatch England has published Safely Home, a report of the problems facing older people and their families when they leave hospital. 15% of patients aged over 65 are readmitted within 28 days. This is both expensive and distressing but the reasons again are complex. Some elderly patients are simply discharged too early because the NHS has so few beds and they are needed for acute medical care. Others develop a relapse of a long term condition or a new illness or injury when they get home. Some of these could be treated at home with the right health and social care support, but this requires significant investment. The struggle to access out of hours care means that many elderly patients are either advised to go, or are taken, directly to emergency departments.
Some patients are kept in hospital longer than needed as commissioners wrangle over whether the NHS or social care service should pay to support their discharge, or try to find a care home bed. And the longer a hospital stay, the more likely an elderly patient will lose function and independence, making it more likely they will be readmitted after discharge.
In England the NHS is stuck with the view of its CEO Simon Stevens, who has asked for only £8 billion extra over the next 5 years in the hope of making £22 billion savings. This has allowed the government to crow that it will give the NHS all the money it needs. But the extra demands on the NHS caused by child poverty, chronic disease, elderly care and cuts to social care and benefits will be huge. Stevens needs to do his sums again, and quick. The NHS is already unsafe and unsustainable.
My book – Staying Alive – How to Get the Best from the NHS – is available here