THE RICHMOND GROUP OF CHARITIES – WRITTEN EVIDENCE (ASC0117)

About The Richmond Group of Charities

The Richmond Group of Charities[1] is a coalition of 12 of the leading health and social care organisations in the voluntary sector. We work together as a collective voice to better influence health and social care policy and practice, with the aim of improving the care and support for the 15 million people living with long term conditions we represent. The Group has a particular focus on the needs of people living with multiple conditions and those experiencing wider forms of disadvantage or discrimination.

The invisibility of adult social care and its consequences

Framing the fundamental challenge facing adult social care as one of ‘invisibility’ does not quite accurately reflect the most pressing challenges: inadequate access to, and the frequent poor quality of, care driven by lack of resource (both funding and workforce). It is certainly true that fixing the problems that beset the social care system have not been traditionally accorded sufficient priority by successive Governments, awareness of those problems and a desire to see them addressed has been growing amongst members of the public. Although social care as an institution is less well understood, there is strong and growing understanding of the challenges, notably the public express concern about workforce issues, the high cost of services (particularly having to sell homes to pay for care) and poor care quality. These, plus the difficulties of accessing care, inadequacy of the services on offer and lack of integration between different parts of the health and care systems are very familiar to people who draw on care and support, their families, providers, the NHS and local government.

Therefore, it is important we do not conflate a lack of political will to act with the visibility of the problems and challenges. Insight from Richmond Group beneficiaries indicates strongly that a more accurate framing is that social care tends to be undervalued, both with respect to its role in enabling to manage their health and live well and the contribution of those working in the sector or providing unpaid care. As a result, social care is failing those who need it most.

Lack of integration and coordination

For people in need of social care services, adult social care can be perceived an integral part of the services and support they need to manage their health conditions, and with that is often thought to be part of the NHS. Recent (unpublished) research conducted by Age UK and Britain Thinks[2] indicates that although awareness is growing of social care specifically, there are clear issues of concern and confusion with how different parts of the care pathway (GPs, social care services, hospitals and community care services) connect to each other. When considered and when experienced, health and care does not feel like a coherent system.

This historical distinction between health and social care is an area identified by many for reform. From the perspective of many service users and families’, the two services are fundamentally interconnected, and ideally service delivery across the system should be seamless (in fact, the links should be invisible). The enhanced healthcare in care homes programme is a clear example of what we can and should aspire to achieve in providing holistic, wrap around support to people living with health conditions, disabilities and/or frailty that has a significant impact on their need for care and support. However, there is much more work that needs to be done to address the barriers to building the right kind of multi-disciplinary team support – with social care as an active and equal partner – in the community.

Lack of resources and workforce

Overwhelmingly the most significant challenge across the social care system, and one that also inhibits better integration, is an acute lack of funding. Social care funding has not kept pace with demand[3] and evidence shows that council spending per person has decreased in the most in more deprived areas[4]. The funding reforms set out so far are a long way off "fixing social care". The Health and Care Levy fails to bridge the funding gap for local authorities, prioritising NHS backlogs in elective care over social care needs. Significantly more funding and reform will be needed to support the growing number of people going without the care they need, raise care quality, stabilise the provider market and ensure ongoing investment[5].

The most significant cost across social care is the workforce. Therefore, a lack of funding in the system has a direct impact on the pay and conditions that providers can offer. It is widely acknowledged that care workers are underpaid and undervalued for the skilled work that they do, and this is evident in the high turnover and vacancy rate[6] - put simply, people can earn more in sectors such as retail, logistics and hospitality for less demanding work. Investment in professionalising the workforce, including addressing pay and conditions, training and career development as well as status will need to be part of any reform and funding package.

It is worth noting that these are long standing issues that predate the pandemic[7]. This picture will only worsen with rising spending pressures year on year across the UK due to a growing and ageing population, rising number of people living with chronic conditions, and increases in the cost of delivering services. The projected gap in funding of both social care and health services (including primary prevention and public health) is important to acknowledge because it is not possible to change for the better when any one part of the system is in perpetual crisis. The NHS, social care and public health have different structures but, like a three-legged stool, fundamentally each needs the others if the system is to function.

The rising prevalence and impact of multiple long-term conditions

In terms of the wider challenges for the social care system, the rising prevalence of multiple long-term conditions (or multimorbidity[8]) is a key consideration. It is estimated that by 2035 68% of the population in England will have two or more long term conditions[9]. In our own research, we see that much of the unmet need for people living with multiple conditions is not biomedical, it is social. We see big challenges with people maintaining their mobility and the consequences for mental wellbeing, social connections, work and financial health[10]. Further, health and social care professionals may not communicate effectively with each other leading to disorganised and fragmented care, and a high treatment burden for service users, carers and families. We need to be prepared to meet the needs of this shift in demographic and in terms of the number of people with significant health needs, and the volume of care (both social and NHS) workload that they generate, people with multimorbidity should be a top priority for improvements in social care.

Our collective evidence strongly suggests that the impact of the pandemic has undoubtably tipped more people into a poorer state of mental and/or physical health. Lack of access to both routine and urgent services has made it more difficult to effectively manage health conditions, and the lack of social care support impacts people’s quality of life. As always, the burden is falling hardest on those in the least advantaged circumstances[11]. Coupled with the cost of living crisis, a debt is building against the nations’ health and wellbeing as finances and health are intrinsically linked.

Better engagement with the VCSE

The VCSE sector has played a vital role in plugging gaps in the system during the pandemic, and charities have been adapting services in order to meet the high demand of unmet need[12]. It has also given us good examples of how powerful partnerships between the public sector and VCSE can be. For social care services to perform at their best in supporting our population to live healthily and well, collaboration will be essential. The VCSE is particularly skilled at working at the nexus between clinical and social need and therefore particularly suited to tackling some of the systems current social care challenges: supporting rehabilitation and recovery post-pandemic; helping people to maintain their wellbeing while waiting for care; and keeping people out of hospital by tackling social and economic factors undermining an individual’s health and resilience.

Better support for unpaid carers

We fail to provide adequate support for the millions of unpaid carers who support so many people, including those with multiple conditions, and who are often themselves living with chronic illness and in the least advantaged circumstances. Around half of carers in England provide care for someone in the same household[13]. The exclusion of unpaid carers from routine, free testing since the universal free testing offer was ended at the end of March 2022 has intensified the perception amongst carers that their contribution is not valued[14].

Informal caregivers of patients with multiple chronic conditions are subsidising the sustainability of a large part of home care provision. However, this very demanding activity causes health problems that increase their own need for health services[15].Research from The Taskforce on Multiple Conditions shows how carers may neglect their own needs to care for a partner or loved one[16] whilst themselves living with multiple conditions. Another recent review[17] highlights common difficulties for informal carers of people with multiple chronic illnesses, including practical challenges related to managing multiple care teams, appointments, medications and side effects, and psychosocial challenges including high levels of psychological symptomatology and reduced social connectedness.

There is an evidence gap for interventions which may help support this caregiver group, so more research and support is urgently needed[18], with increases in the pensions and benefits that people who provide unpaid care receive, and reducing barriers to respite care, being  important places to start.

Putting co-production at the heart of care

VCSE organisations understand that being well is not just about being free of illness. They know how to support the whole person, beyond their medical treatments, in order to improve health and wellbeing. People’s financial stability, their living environment and how supported they feel by their families and communities are just a few of the wider determinants of their health and wellbeing. VCSE organisations can address these factors and improve people’s health and wellbeing in a wide variety of ways; for example, by offering emotional support, information and advice, or by providing practical help, as well as through leading research, innovation and system redesign.

The Richmond Group’s added value is our deep understanding of the insights and lived experience of our 13 million beneficiaries.  We want the social care system (alongside the wider health system) to focus on patient experience and outcomes that matter to real people, and draw on our insights more often. Voices of lived experience are not sufficiently heard, and this has impact on those who draw on care and support.  This shift of mindset must include cultivating leaders and managers who understand the realities of partnership working and can build resilient relationships with the voluntary sector and others. It will also require a change of mindset at national level towards fostering and rewarding the use of these partnership skills. The best way of delivering bottom-up integration is by working outwards and upwards from how people and communities describe their needs and experiences.

27 May 2022