Written evidence submitted by Healthwatch England (ASC0106)

 

 

Healthwatch England’s evidence submission

About Healthwatch 

  1. Healthwatch England is the independent statutory champion for people who use health and care services. We were launched in 2013 – along with a network of 153 local Healthwatch – to ensure that those who run local health and care services understand and act on what really matters to people. Our remit covers adult social care experiences and patient experiences of NHS services.
  2. A local Healthwatch exists in every area of England. We support them in their efforts to find out what people want from health and care services and advocate for services that work for local communities. Local Healthwatch also acts as our eyes and ears on the ground, telling us what people think about local health and social care services.
  3. We use the information the network shares with us and our statutory powers to ensure the public's voice is strengthened and heard by those who design, commission, deliver, and regulate health and care services.

Our work on social care reform

  1. Healthwatch has long called for a long-term, fully funded plan for Adult Social Care.
  2. Healthwatch England submitted evidence to inform the previous Government’s social care reforms from 2021 to 2024 using insight from our own work and the wider Healthwatch network. We welcomed the proposals as a move towards more personalised and accessible social care.
  3. We welcome the current Government’s commitment to a social care plan alongside the 10-Year Health Plan. However, we are concerned about continued delays to reform and the impact this is having on those who draw on care, unpaid carers, and groups experiencing unmet needs.

What is the cost of inaction to individuals and how might people’s lives change with action on adult social care reform? 

  1. Healthwatch England and the Healthwatch network consistently hear directly from people about how an unreformed social care system impacts their lives.
  2. Recent evidence includes Healthwatch Oxfordshire’s work on social care issues during hospital discharge, which found significant delays in accessing vital social care support.
  3. Unpublished Healthwatch analysis of thousands of pieces of social care feedback in July 2024 found that people were struggling due to the cost of essential care in the current (unreformed system). An unpublished interview conducted in 2023 with a care self-funder highlights the huge difficulties of affording care. “I pay for my own social care in full which accounts for 37% of my total income…. I could not manage without the carers calling in daily as they provide help with my personal care such as showering, changing etc.”
  4. While delayed reform is having impacts on those who currently receive care, it is also affecting people who may be entitled to social care but cannot access it.
  5. In July 2024, we published research on unmet social care needs in working-age adults. This found that up to 1.5 million people may be eligible for social care but are not receiving it.
  6. The primary driver of this unmet need is a lack of availability or awareness of social care. The current system, with no united branding or single front door, cannot properly address this issue.
  7. Positively, amongst those the existing system does support, three-quarters of people say that care helps them live the life they want to live.
    1. 62% say care helps them stay healthy
    2. 51% say it helps them do the activities they like
    3. 47% say care supports them to keep themselves and their home clean, and to eat and drink properly
  8. However, only 22% say care supports them to work, study, or volunteer.
  9. And those who are not accessing care are unable to access a range of activities.
  10. Disabled adults who are not accessing formal social care support but self-identified as eligible under Care Act criteria told us about things they would like to be able to do, but cannot due to their disability:
    1. Sport/physical activity – 51%
    2. Maintain relationships with friends and family – 42%
    3. Working – 42%
    4. Go to music or sports events, the theatre or the cinema – 37%
    5. Visit friends and family – 33%
    6. Go to restaurants, cafes, and pubs - 32%
    7. Move into full time employment – 24%
    8. Volunteering – 21%
  11. We believe that social care reform has the potential to address unmet care needs through a far more preventative system, where community-based solutions allow a wider range of needs to be met.
  12. Furthermore, our research on Information, Advice and Guidance in social care from 2022 found that there was poor awareness of where to go to access social care services and about social care assessments.
  13. Only 15% of people initially knew to contact their local authority for a care assessment, which contributed to only half of those with self-identified additional needs accessing care and support.

Where in the system is the cost of inaction on adult social care reform being borne the most?

  1. Unpaid carers bear some of the greatest burden of the failure to reform social care. Unpublished analysis of Healthwatch insight (July 2024) suggests that carers’ health is suffering through the pressures of caring and this pressure increases when paid care packages fail (i.e. due to funding issues or care workforce shortages).
  2. Research by Healthwatch in Devon, Plymouth and Torbay of people providing more than 20 hours of unpaid care a week found that nearly two-thirds feel overwhelmed by their role with the unavailability and inconsistency of paid regular and respite care a significant pressure on them. One carer told them: “When I am unable to obtain regular personal time and space, I begin to feel burnt-out and overwhelmed, and therefore lacking the energy and patience required in providing the care which is needed.”
  3. Research by Healthwatch South Cumbria research in 2023 paints a clear picture of strain on carers with over a third of those surveyed reporting poor mental wellbeing.
  4. Our insight echoes the findings of other organisations such as Carers UK that an unreformed care system has a deleterious effect on the lives of unpaid carers.
  5. We have called for reforms to Carer’s Allowance, including increasing the total benefit provided, access to more funding for those caring for multiple people, moving to an hour-of-work limit, and allowing more than one carer to claim for the caring of an individual.

Further Healthwatch work and engagement

  1. Healthwatch England is keen to engage with the committee to support this enquiry. We are actively exploring further work around social care reform, and we are happy to produce a bespoke analysis of Healthwatch insight for the committee. All unpublished material is available to the committee on request.

 

 

December 2024