“A politician is like the person who would build an ambulance at the bottom of the cliff, instead of constructing a good fence at the top.”
Never did the phrase seem so apt as last week when NHS leaders warned that A&E departments are reaching a ‘cliff edge’ – no longer able to guarantee the provision of safe and high quality medical and nursing care.
Many factors have been blamed for this crisis- a lack of GP out-of-hours care, the introduction of the non-emergency NHS 111 line, an ageing population. But the elephant in the A&E waiting room is undoubtedly the lack of focus on preventative health care.
‘Early intervention’ is the current buzzword for politicians of all colours (who never miss an opportunity to assert their commitment to what they see as the cure for almost all the economic and social ills of this country). However, evidence of this being put into practice on the ground is somewhat lacking.
Take the care bill currently going through parliament, which aims to put the social care system on sustainable footing once and for all after years of neglect. Much of the debate on this issue has centred around the needs of an ageing population and the rights and wrongs of the ‘cap’ on care costs. However, the true barometer of success for the bill will be whether the ‘national eligibility threshold’ for care – ie who gets it – is set at a level to ensure a truly preventative care system is established.
Research by LSE on behalf of Scope has found that over 100,000 disabled people who need social care to do the most basic tasks in life – get out of bed in the morning, get washed, get dressed – stand to lose out on support if the government sets the national eligibility threshold too high. And this disregard for the right of disabled people to lead independent lives with dignity not only has tragic human cost – the economic implications are equally severe.
Ignoring these 100,000 disabled people will not make them go away. If their needs are not met in the care system then they will simply escalate to a point where they have to be dealt with further down the line once they reach crisis point. And this doesn’t come cheap – longer hospital stays, frequent re-admissions, even the need for residential support – not to mention the lost tax revenues as a result of disabled people having to give up work as a result of losing social care support (affecting one in three of all working aged disabled people).
Scope’s Ending the Other Care Crisis report, which contains economic modelling by Deloitte, has found that, far from being a drain on resources, for every £1 spent on support for disabled people with ‘moderate’ FACS (fair access to care services) level needs, savings of £1.30 are created. So if you consider that providing ‘moderate’ care for working age disabled people will cost £1.2bn, the potential benefits amount to £1.6bn, including an additional £0.4bn returning to the Treasury.
But this isn’t simply about dumping yet another problem on the door of local government, who are already being hit by crippling budget cuts, and letting others reap the benefits. Drawing on the consensus reached in the joint parliamentary inquiry into social care for working aged disabled people, Scope, and four other national disability charities are recommending that councils and health commissioners, through health and wellbeing boards, should jointly invest in preventative social care through accessing at least £1.2bn from the NHS budget.
And surely this is at the heart of what Labour’s vision of ‘whole person care’ is about? Ensuring key decision makers from councils, clinical commissioning groups, social services, public health bodies, all come together to better understand their local community’s needs, and work in a more joined-up way. This will undoubtedly ensure that a preventative care system is created for care users – particularly the forgotten third, who are working aged disabled people.
Labour are proud of their record on early intervention – notably around the introduction of Sure Start and their work on the ‘troubled families’ agenda. And backing reforms to social care which focus on prevention – building a ‘fence at the top of the cliff’- is an excellent way to demonstrate their credentials as a credible government in waiting.