Factors like physiotherapy provision are key to relieving pressure on the social care system, but all too often good solutions are lost in the noise over self-funding of care, reflects Rob Yeldham the CSP's director of strategy, policy and engagement.
When we think of adult social care we don’t always think about physiotherapy. Yet some chartered physios and physio support workers work directly in adult social care and most physios and associate professionals support older patients and patients with disabilities or long term conditions who are also social care users or who are likely to need social care as frailty or disability increases.
The role of physiotherapy in minimising or delaying decline, and therefore reducing the intensity of need for social care is critical. It is estimated that local councils spend hundreds of millions a year on social care costs which could be avoided with better access to community rehab.
Integrate rehab and social care
As community physiotherapy continues to expand, as proposed by the Labour government in England, the overlap between rehab and social care will become more blurred and services will increasingly be working in a more integrated way across the health and care boundary. In many places this is already the norm. So, what is on the horizon for the sector?
The adult social care sector is pressing for the governments in England, Scotland and Wales to do more to address the scale of demand of adult social care, felt to be unfair charging systems and workforce shortages. Some of the challenges are the same as faced by health services but in a context of less generous Treasury funding in past years.
A new national care service
Labour in England has acted to increase pay for care workers. They are slightly increasing social care funding for local councils and have allocated new money for older people and people with impairments to adapt their homes. Training for care workers to perform health checks at home has also been announced. Health and Care Secretary Wes Streeting has now also announced an independent review of social care.
The review will be led by Baroness Louise Casey. Final recommendations for social care in England by the end of 2028. One of the key things to clarify is what is meant by the UK government’s commitment to establishing a “National Care Service”. At times it has felt like the “National Care Service” is a slogan in search of a policy.
Defining the problem
The Scottish government has run into trouble with its commitment to establishing a Scottish national care service and developments in Wales have been slow. Northern Ireland already has a notionally integrated health and care system, although in practice the degree of integration is limited. Beyond setting national standards for care there is no consensus about what a national care service should be and whether it should incorporate any services currently part of the NHS or not.
The latter issue has been one of the problems in Scotland with no consensus about what should be in or out of the remit of the service and a risk of disruption if significant changes are made.
Past reviews of social care in England have often been diverted into debates whether the value of people’s homes should be factored into the contributions social care users make towards the costs of care. These miss the more fundamental points that fair access, better quality of care and a skilled workforce all need sustained and adequate funding, regardless of how the money is raised. Hopefully the Casey review won’t fall into the trap of focusing solely on debating whether to protect people’s inheritances. Quantifying what we need to spend to provide decent levels of care should be the starting point, with the options for funding properly discussed to achieve a cross party consensus.
CSP backs universal access
In light of these ongoing developments, we at the CSP is reviewing our policy on social care. Currently our policy covers the funding and integration of social care and the need for the links between rehab and social care to be reflected in both health and care policy. The CSP’s starting point is that social care, like health care, should be universally available for those who need it, free at the point of use and funded from fair general taxation.
We support the integration of health and care services, but this should aim to personalise care for the individual, rather than focus on organisational structures or mergers
We believe that care home residents should be able to access rehab in their homes, whether through local NHS services, social care providers or private practitioners.
Give us your views
We recognise that physios and support workers employed by charities, and self employed physios, have a particular role to play in social care.
We see there being the potential for physios to play a bigger role in aspects of social care management, especially given the need for rehab to be built into social care provision.
We will make representations to the review on behalf of the profession in England, as we have already done in Scotland. To inform this we will be seeking views from expert members and partners, not least through the recognised professional networks specialising in the client groups of adult social care services.
If you have expertise in this field which you’d like to contribute, please get in touch via enquiries@csp.org.uk.
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