"The loss of community hospital beds was intended to be offset by increasing the capacity of community care... Unfortunately there is not sufficient capacity in the home care services to do this job."

Recently, the Minister for Health's remit was expanded to include Social Care:
Jeremy Hunt becomes secretary of state for health and social care - Community Care

Jeremy Hunt, now secretary of state for health and social care, will take over the preparation of the government's policy paper (known as a green paper) on social care which is due in the summer of this year. Previously, the work was being done in the Cabinet Office and overseen by Damian Green (now no longer in government). As one source put it, rather than having three Whitehall departments trying to run the process, at least now it will be led by one.

Will a rebranded Department of Health change anything? - BBC News

Jeremy Hunt is to take charge of a government inquiry into how to pay for care for elderly people, but funding for the sector will remain under the control of the local government department... But the move sparked scepticism from some long-term observers who doubted it would transform the health of a sector that has seen cuts of up to £6bn since 2010.

Jeremy Hunt’s beefed up social care role met with scepticism

These social care budgets are fed through county councils - who have less to spend:
Futures Forum: Devon increases funding on adult social care: "With less money in the pot, councils are having to spend a higher proportion of their finances on the things they have a legal duty to do - like social care."

There have been promises to bring both systems together - but it isn't working here in Devon:
Futures Forum: Care Closer to Home: It's Not Working > new video from Save Our Hospital Services Devon

So who is to blame for the difficulties?

East Devon MP Hugo Swire looks at the issues in a piece in the latest Herald:

Opinion: Courage and leadership is needed to save the NHS

26 January 2018

East Devon MP Sir Hugo Swire says the integration of social and health care is needed to save the NHS.

A political consensus is emerging here at Westminster about what has to be done to save the NHS, which we all know is in crisis.

The main cause that has been targeted is social care, which has been created by an ageing population and yes, cuts to local Government.

Jeremy Hunt has now persuaded the Prime Minister to bring social care into the NHS, which is a good thing, but in my books the budget, which currently sits at the Ministry for Housing, Communities and Local Government also needs to be transferred.

The NHS rather than councils should be in charge of commissioning social care.

As we all know, old age is a condition lottery; one person might require £100,000 of 
care, another £20,000. Is it not a fairer solution to pool the risk between as many people as we can so that everyone loses something but nobody loses everything?

In my view, the so called ‘dementia tax’ was a good manifesto pledge because it suggested those who own their homes contribute to their own care rather than allowing our children and grandchildren, who are finding it difficult to get on the property ladder themselves, to pay for it. But it was flawed because it didn’t have a cap, which meant it failed to pool that risk.

Just how should we pay for it? Anyone I speak to seems to suggest that they wouldn’t 
mind paying a bit more in tax to sort it out. But how? Take 
money out of peoples’ estates after they die? Labour tried 
that, and it was quickly dubbed, by my side, as being a ‘death tax’.

Maybe the Government could raise tax by means-testing pensioners benefits such as winter fuel allowances and ending the pension triple lock, but again whenever this has 
been floated there has been opposition to it, most recently by the DUP.

Another idea floating around Parliament is turning national insurance into a ring-fenced health tax. Sarah Wollaston, the Conservative chairwoman of the Health Select Committee believes national insurance should also be extended to those beyond retirement age who are presently exempt.

I have spoken to Jeremy Hunt many times about social care and the truth is he is not wedded to any one idea, he is ‘open to all options’, including a dedicated tax, because he knows more money must be found and fast.

What is needed is courage and leadership to drive forward solutions, but integrating social and health care must be the right place to start.

How can we save the NHS? | Latest Sidmouth and Ottery News - Sidmouth Herald

Devon County Councillor Martin Freeman has pointed to the lack of funding:
Futures Forum: The poor state of our health and care system >>> who do we blame?

And his colleague Cllr Claire Wright reports on Sidmouth GP Dr Mike Slot addressing the County Council:

Care at home isn’t working, Sidmouth GP tells Devon County Council’s Health Scrutiny Cttee

Saturday, 27 January 2018 0 Comments by Claire

Carers aren’t available to look after people in their homes, a Sidmouth GP told Devon County Council’s Health and Adult Care Scrutiny Committee on Thursday (25 January).

So concerned at the unavailability of care in people’s homes - the service designed to replace community hospital beds, Dr Mike Slot travelled to County Hall to share his concerns with the health scrutiny committee.

After he had finished his submission I tried to ask a question, but was prevented from doing so by the chair and scrutiny clerk, who informed me that it was against the rules for councillors to ask questions of public speakers! This was the first I knew of it since my proposal to bring in public speaking to scrutiny was agreed two years ago.

The Head of Social Care and the committee chair both intimated that Dr Slot’s view may be an isolated one…. I am less convinced.

At the end of the meeting in the work programme I successfully proposed a spotlight review to investigate Dr Slot’s concerns fully.

Another member of the public was told she was not able to speak to the committee because she missed the deadline, despite there being slots available. I have since contacted the officer presiding over the Procedures Committee (which I am a member of) to get the rules reviewed. They will now be debated at the the April committee.

I asked Dr Slot for a copy of his speech, which is below.

The loss of community hospital beds was intended to be offset by increasing the capacity of community care so that patients could be cared for in their own homes. This may or may not have been realistic since many of the patients in the hospital system cannot be managed in the community even with excellent community services.

However, with or without community hospital beds it is an excellent idea to expand community services so that all those patients who can be cared for out of hospital can remain at home. Unfortunately there is not sufficient capacity in the home care services to do this job.

When GPs ring the single point of access number asking for rapid response or night sitting, the carers are not available. This is partly due to lack of resources and partly due to difficulty with recruitment. I suspect that part of the difficulty with recruitment may be due to the terms and conditions. If the carers only get paid if they are required then this may not be particularly attractive.

We understand that a hospital only functions well with a maximum of 85% bed occupancy, and similarly with the home care service we need to accept that there will be some unused capacity otherwise the service is never able to accept unexpected cases. Thus we need to allocate enough resource so that we can offer both an attractive rate of pay and attractive terms and conditions.

This is in fact an essential part of the answer to the problem the entire NHS is experiencing. If the level of water in a reservoir is steadily rising and then overflows, you can either try and build the banks higher in which case it will just overflow a bit later, or you can look at the streams going in and going out of it.

Similarly when you see an overflowing A&E or hospital, you can buy more A&E or acute beds (very expensive) or you can increase community capacity to prevent people going in and facilitate people coming out (relatively much cheaper but you still have to pay a proper rate for it).

Pic: Dr Slot presenting to the committee last Thursday.

Care at home isn’t working, Sidmouth GP tells Devon County Council’s Health Scrutiny Cttee - Claire Wright.
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