Sean Harriss, Senior Advisor at PPL, talks about how viewing social care as a ‘hospital discharge service’ means the full value of social care isn’t realised.

There is considerable interest, and some may even say a hint of excitement, that we have a new Government and what that may mean for tackling some of the huge challenges in health and care.

As we see the debate play out about how broken the NHS is and the balance of reform and the need for extra money it still feels, however, very much like social care is an afterthought, if a thought at all…

As a Senior Advisor at PPL, the UK’s leading social enterprise management consultancy, working with a number of health and care systems, particularly around the interface between the NHS and Social Care and as a NHS NED, it never ceases to amaze me how limited the understanding of the role of social care is among the Leadership of both NHS England (NHSE) and the Department of Health and Social Care (DHSC).

This is a real problem and one that is not discussed enough!

Pretty much every leadership conversation in the NHS now is about three things: Emergency Department performance, finance (or more precisely deficits) and elective recovery. All of these are no doubt very important priorities, but what is measured is managed and that in turn means there is little space for social care except as an improver of flow through the acute hospital system and in particular on hospital discharge.

This very narrow view of social care as a ‘hospital discharge service’ means that the full value that social care can play is not realised and even more importantly in the short term it means that there is no direction or incentive for NHS system leaders to understand social care better.

So, what are some of the common issues and challenges that this presents? They include:

• There being a lack of understanding in primary and secondary care that social care is not free at the point of delivery and that the charging regime is complicated and creates a significant barrier to access.

• That local authorities legally must set a balanced budget and can’t run deficits; this leads to squeezed funding and commissioning and service provision being too often based on costs and not outcomes.

• Social care is much more than a service for frail elderly people either at home or in residential care with up to 50% of budgets being spent on mental heath and adults with learning and physical disabilities.

• That despite the dedication and skill of the social care workforce it isn’t as valued or well trained as even the most junior NHS staff and that care workers are frequently on very low wages, poor terms and conditions and zero hours contracts.

• The lack of funding for social care has a direct impact on health outcomes, prevention and ultimately hospital flow and clinical and financial targets.

So, what should be done? Change starts at the top and with leadership. While those responsible for NHSE and DHSC only send messages about narrow NHS priorities and treat social care as a transactional discharge service this will model behaviour through the system in integrated care boards (ICBs) and individual Trusts. Therefore, to see an improvement in outcomes there are some key changes that can be made:

• Increase the understanding and practical experience of social care of NHSE and DHSC leaders.

• Make this a similar objective for the leadership of ICB’s and Trusts.

• Bring more people with social care knowledge and experience into leadership positions across the system as a whole.

• Invest in the skills and expertise of leaders, managers and staff in social care.

• Ensure that funding and reform of the NHS covers social care as an equal partner not an after thought.

• Require local Trusts, local authorities and ICBs to produce and prioritise wholistic plans for prevention, deflection, integration and joint working

But most of all, only through an increased level of understanding and empathy will social care move from being seen as a hospital discharge service to one that is a true partner for improving health outcomes and quality of life.