Brexit: Make it better or make it worse

The UK’s discussions about and preparations for exit from the European Union are having a profound impact on our society in a way that we haven’t seen for generations. No-deal Brexit is dominating the country, and the NHS and adult social care are certainly not unaffected by its impact. 

We know our NHS colleagues are very aware of the crisis in social care. Since 2010, £7.7bn has been taken out of councils’ budgets in England due to policies of austerity, while demand for support and care has been and continues to grow.

The care market is worryingly fragile. Our 2019 budget survey found that over two thirds of directors of adult social care in England have had a care home closure, a provider ceasing to trade, or contracts handed back to the council in the past six months alone – impacting more than 10,000 people needing care altogether. 

The closure and cessation of essential community services also meant an increase in the pressure felt by the acute NHS. The NHS cannot truly succeed without a well-funded, sustainable social care system in place.

Currently, there is no long-term funding settlement and no long-term plan for social care. NHS colleagues cannot change that; however, the NHS and social care are interdependent and NHS colleagues DO have the power to make things better or worse for local systems, for Brexit and winter too.

Making things better involves planning together, knitting social prescribing into councils’ wider involvement with communities and considering how the whole system (including family carers and communities) are affected. 

Things to avoid

In our view, there are three key things to avoid to not make things worse. First, in the event of a crisis, the NHS will undoubtedly see a spike in demand for hospital care unless we approach this together.

It’s easy, in times of crisis, for hospitals to consider buying social care as a quick solution to discharge and treat more and more people, and more and more quickly. But the NHS panic buying social care is a high-risk activity for any system that impacts individuals beyond what we can imagine.

Providers will likely charge more in these circumstances than they would usually charge councils, without necessarily increasing system capacity either. Staff will just move from one employer to another.

As a result, either the public purse will end up paying more for the same, or there will be fewer care staff available to support people at home – where they want to be – thus failing to avoid unnecessary hospital admissions or failing at providing the personalised and valued care people in need deserve. It’s a catch-22 situation. 

Second, we have become more aware of the need to look more closely at what is described as “reablement”, “discharge to assess” or “trusted assessment” and not taking it at face value, especially in residential and nursing homes. If there are no therapists and reablement staff or assessors, then people are no less likely to “decondition” than in hospital.

It’s easy, in times of crisis, for hospitals to consider buying social care as a quick solution to discharge and treat more and more people, and more and more quickly. But the NHS panic buying social care is a high-risk activity for any system

We would question whether people really understand these moves might not be temporary – they are highly likely to become long term – thus becoming a terribly disheartening result for the person who probably would have just wanted to go back home.

On top of a poor outcome for the individual, this also locks up funding long term to the detriment of the whole health and social care system. 

And finally, consideration of the system’s workforce is also pivotal. EU citizens make up 8 per cent of our adult social care workforce – a percentage that in many areas of the country is much higher.

While the shortage of nurses and care assistants is highly visible in hospitals, it’s even more so in our nursing homes and the community. Adult social care is already struggling to attract staff when wages are higher in the NHS.

While we welcome the living wage, this has also resulted in some staff moving onto other sectors. On top of this, the weakened pound is already making England a less attractive place for an overseas workforce.

If hospitals are the pivotal focus and staff move from social care and the community, while we have less people willing to work in care, we are merely increasing an unending cycle of crisis. 

Ultimately, during such a crucial time, neither adult social care nor the NHS can afford to lose support from each other. Not only would it make things worse for those who need care and support, but it’ll also hit the NHS hard, and impact on those needing healthcare and treatment.

It is imperative that the NHS and social care work together in a mutually-beneficial partnership to overcome these times of uncertainty and come out on top of the impactful consequences a no-deal Brexit would have on both, and on the country as a whole.