AFC0022

 

Written evidence submitted by Royal Star and Garter.

Background

 

  1. Royal Star & Garter (charity number 210119) provides care for veterans and their partners living with disability or dementia, in Care Homes and through services reaching into the community, including Day Care, Lunch Clubs and a Telephone Friendship Service. We are recognised as one of the leading providers of social care services to the Armed Forces community.

 

  1. The first Royal Star & Garter Home in Richmond opened in January 1916, under the auspices of the British Red Cross, to care for severely disabled young men returning from the battlegrounds of the First World War. We have over a century of experience in providing nursing and therapeutic care to veterans living with a range of complex disabilities and dementia. We have since expanded our remit to support the partners of veterans and by the nature of the care we provide we offer an extended arm of support to the wider Armed Forces community including families. Our highly skilled, motivated staff meet the needs of the veterans that we care for in a personalised and compassionate way.

 

  1. We are committed to sharing our knowledge, skills and experience with other organisations to promote better care for all veterans and their partners. In 2023 we established the Veteran Friendly Framework, in partnership with the Royal British Legion and the NHS Veteran Covenant Healthcare Alliance. Designed for use in residential settings for older people, the Framework helps all care providers to offer appropriate support for the thousands of veterans living in care homes across England. The Framework supports care providers in identifying veterans and their needs, addressing social isolation and providing signposting to statutory and charitable services.

 

  1. We are proud to be a signatory of the Armed Forces Covenant (AFC) and to have achieved Gold Standard in the Defence Employer Recognition Scheme.

 

 

Evidence

 

  1. Our evidence will focus on the need to expand the scope of the AFC to include social care services.

 

  1. 26,500 veterans are living in care homes in England alone (2021 National Census), and there will be many times more veterans, and their partners and families, accessing the full range of social care services such as day care, home care or respite services.

 

  1. We work closely with several local authorities as well as professional and commercial partners, and representative social care bodies such at the National Care Forum. In our experience, awareness of the AFC remains low in the social care sector. Low awareness is driven by the fact that the AFC does not include social care within scope, solely health. This is despite the direct linkages between health and social care being well established and the fact that social care is funded in a mixed model of private, local authority and NHS fees. A large, often publicly funded, sector has been placed unnecessarily outside of the scope of the AFC.

 

  1. Adult social care services support individuals of all ages, including those of working age and those who have acquired disabilities and injuries through accidents or illness. Inevitably, social care services directly support members of the Armed Forces community, some of whom will have been medically discharged and be in need of immediate care and support.

 

  1. Skills for Care estimate that 18,500 organisations were involved in providing or organising adult social care in England, as at 2023/24. Those organisations delivered services in an estimated 40,000 establishments. The number of people working in adult social care was estimated at 1.59 million. The adult social care sector was estimated to contribute £68.1 billion GVA per annum to the economy in England.

 

  1. The forthcoming government reform plans underscore the belief that the NHS must be fixed, and that social care requires fundamental reform. Other government announcements aimed at ‘transforming social care’ include increased support to digitise and integrate care records with GP records and better integration of health and social care services. These are welcome measures, as is the announcement of a commission on social care led by Baroness Louise Casey. It is imperative that the unique needs of veterans who rely on the adult social care system are recognised within the government’s reform agenda. The expansion of AFC duties to include the social care sector would be an important marker for this.

 

  1. There are national NHS-funded programmes to accredit both NHS Trusts (Veteran Covenant Healthcare Alliance) and GP practices (Royal College of General Practitioners) to become ‘veteran aware’, and so better support the needs of those who have served and their families. No such national programme yet exists for social care, beyond the Veteran Friendly Framework programme [see point 3] which has to date been established on a pilot-basis using charitable funding.

 

  1. The number of people eligible for NHS Funded Nursing Care (FNC) was 75,748 (end Q4 2023-24). FNC is the funding provided by the NHS to registered ‘care homes with nursing’, to support the provision of nursing care by a registered nurse. The number of people eligible for NHS Continuing Health Care (CHC) was 52,096 (end Q4 2023-24). CHC means a package of ongoing care (often in a care home) that is arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework. FNC and CHC payments are made directly by the NHS, generally through Integrated Care Boards, to social care providers. Section 1.10 of the AFC states: When relevant functions have been contracted out to private companies or third sector organisations, the specified public body responsible for that function needs to ensure that any third parties exercising functions on their behalf are required to comply with the Covenant Duty and do so in practice. Therefore, the responsible public body might wish to reflect the Duty in the contracts it has with contractors exercising relevant functions on its behalf. At present, this is not the case for FNC or CHC payments made through the NHS to care homes. There is no (or at least no consistent) reference to AFC duties in local contracts or the Department of Health & Social Care ‘National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care’ (revised July 2022).

 

  1. The AFC has proven to be a vital mechanism to better recognise and represent the value of those who have served and should be fully enshrined in law. The discrepancies highlighted above demonstrate why social care should be specifically included within the scope of the AFC. This will avoid artificial and arbitrary boundaries being applied between health and social care systems when none should exist. For the veterans accessing services, whether through the NHS or care providers, their service should be seamlessly recognised throughout the care pathway.

 

17th January 2025